title: Role of endoscopic stents and selective minimal access drainage in oesophageal leaks: feasibility and outcome.
abstract: BACKGROUND
  Leaks following oesophageal surgery are considered to be amongst the most dreaded complications and contributory to postoperative mortality. Controversies still exist regarding the best option for the management of oesophageal leaks due to lack of standardized treatment protocols. This study was designed to analyse the feasibility outcome and complications associated with placement of removable, fully covered, self-expanding metallic stents for oesophageal leaks with concomitant minimally invasive drainage when appropriate.
  
  
  METHODS
  The study group included 32 patients from a prospectively maintained database of oesophageal leaks, with the majority being anastomotic leaks after minimally invasive oesophagectomy (n = 28), followed by laparoscopic cardiomyotomy (n = 3) and extended total gastrectomy (n = 1). The procedures took place between March 2007 and April 2013.
  
  
  RESULTS
  Most patients had an intrathoracic leak (n = 22), with a mean time to detection of the leak following surgery of 7.50 days (SD = 2.23). Subsequent to endoscopic stenting, enteral feeding via a nasojejunal tube was started on the second day and oral feeding was delayed until the 14th day (n = 31). Six patients underwent thoracoscopic (n = 5) or laparoscopic drainage (n = 1) along with stenting for significant mediastinal and intra-abdominal contamination. The stent migration rate of our study was 8.54%. The overall success in terms of preventing mortality was 96%.
  
  
  CONCLUSIONS
  Endoscopic stenting should be considered a primary option for managing oesophageal leaks. Delayed oral intake may reduce the incidence of stent migration. Larger stents (bariatric or colorectal stents) serve as a useful option in case of migrated stents. Combined minimally invasive procedures can be safely adapted in appropriate clinical circumstances and may contribute to better outcomes.
authors.affiliation: Department of Upper GI Surgery and Therapeutic Endoscopy, GEM Hospital, 45/A Pankaja Mill Road, Ramanathapuram, Coimbatore, 641045, India, drpsr@yahoo.com.
authors.forename: P S
authors.initials: PS
authors.lastname: Rajan
authors.forename: S
authors.initials: S
authors.lastname: Bansal
authors.forename: N S
authors.initials: NS
authors.lastname: Balaji
authors.forename: S
authors.initials: S
authors.lastname: Rajapandian
authors.forename: R
authors.initials: R
authors.lastname: Parthasarathi
authors.forename: P
authors.initials: P
authors.lastname: Senthilnathan
authors.forename: P
authors.initials: P
authors.lastname: Praveenraj
authors.forename: C
authors.initials: C
authors.lastname: Palanivelu
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000175:diagnosis / Q000628:therapy*; D002299:Cardia / Q000601:surgery; D020878:Device Removal; D004322:Drainage / Q000379:methods*; D004750:Enteral Nutrition; D016629:Esophagectomy; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D005548:Foreign-Body Migration / Q000209:etiology / Q000601:surgery; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013906:Thoracoscopy