title: The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations.
abstract: OBJECTIVE
  The aim of this review was to assess the safety and effectiveness of esophageal stents in the management of benign esophageal perforation and in the management of esophageal anastomotic leaks.
  
  
  BACKGROUND
  Benign esophageal perforation and postoperative esophageal anastomotic leak are often encountered. Endoscopic placement of esophageal stent across the site of leakage might help control the sepsis and reduce the mortality and morbidity.
  
  
  METHODS
  All the published case series reporting the use of metallic and plastic stents in the management of postoperative anastomotic leaks, spontaneous esophageal perforations, and iatrogenic esophageal perforations were identified from MEDLINE, EMBASE, and PubMed (1990-2012). Primary outcomes assessed were technical success rates and complete healing rates. Secondary outcomes assessed were stent migration rates, stent perforation rates, duration of hospital stay, time to stent removal, and mortality rates. A pooled analysis was performed and subgroup analysis was performed for plastic versus metallic stents and anastomotic leaks versus perforations separately.
  
  
  RESULTS
  A total of 27 case series with 340 patients were included. Technical and clinical success rates of stenting were 91% and 81%, respectively. Stent migration rates were significantly higher with plastic stents than with metallic stents (40/148 vs 13/117 patients, respectively; P = 0.001). Patients with metallic stents had significantly higher incidence of postprocedure strictures (P = 0.006). However, patients with plastic stents needed significantly higher number of reinterventions (P = 0.005). Mean postprocedure hospital stay varied from 8 days to 51 days. There was no significant difference in the primary or secondary outcomes when stenting was performed for anastomotic leaks or perforations.
  
  
  CONCLUSIONS
  Endoscopic management of esophageal anastomotic leaks and perforations with the use of esophageal stents is technically feasible. It seems to be safe and effective when performed along with mediastinal or pleural drainage. Esophageal stent can, therefore, be considered as a treatment option in the management of patients who present early after esophageal perforation or anastomotic leak with limited mediastinal or pleural contamination.
authors: *Belfast Health and Social Care Trust, Belfast, United Kingdom; †Ulster Hospital, Belfast, United Kingdom; and ‡Craigavon Area Hospital, Craigavon, United Kingdom.
authors: Bobby V M
authors: BV
authors: Dasari
authors: David
authors: D
authors: Neely
authors: Andrew
authors: A
authors: Kennedy
authors: Gary
authors: G
authors: Spence
authors: Paul
authors: P
authors: Rice
authors: Eamon
authors: E
authors: Mackle
authors: Emmanuel
authors: E
authors: Epanomeritakis
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000453:epidemiology / Q000601:surgery*; D004939:Esophageal Perforation / Q000401:mortality / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D014943:Global Health; D006801:Humans; D015994:Incidence; D008477:Mediastinal Diseases / Q000401:mortality / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011474:Prosthesis Design; D012086:Reoperation; D015607:Stents / Q000592:standards*; D015996:Survival Rate / Q000639:trends; D004935:Esophageal Diseases; D012422:Rupture, Spontaneous; D000072663:Spontaneous Perforation