Closure of benign leaks, perforations, and fistulas with temporary placement of fully covered metal stents: a retrospective analysis.
BACKGROUND
Partially covered self-expanding metal stents (SEMS), have been suggested as an alternative to surgery in the treatment of esophageal fistulas of benign etiology. Nevertheless, uncomplicated removal remains difficult. The use of fully covered (FC) SEMSs could solve this problem.


OBJECTIVE
To review our experience with FC-SEMS placement in patients with benign upper gastrointestinal leaks or perforations. We wanted to assess successful closure of the perforations and short-term and long-term complications.


METHODS
Multicenter study, including 3 tertiary centers. Retrospective review of patients who underwent FC-SEMS placement for benign perforations.


RESULTS
Eighty-eight stents were placed in 56 patients. We achieved leak closure in 44 patients (78.6%). There were 18 migrations. All of them could be solved endoscopically. A severe septic situation was associated with a higher mortality rate (27.6% vs. 7.4%; P=0.049) and a lower success rate (34.5% vs. 7.4%; P=0.088), compared with those patients who did not present severe sepsis. However, these differences could not be confirmed by multivariable analysis. The results in the subgroup of 11 patients with leaks after sleeve gastrectomy were also good (73% success without surgery and 0% mortality).


CONCLUSIONS
Temporary placement of FC-SEMS for benign perforations, fistulas, and leaks is feasible in sealing the leaks. All migrations could be solved endoscopically. It is very important to insert the stent before sepsis is established. This article also would be an addition to the growing body of literature supporting stenting as a good alternative if not standard approach to controlling these leaks.
*Department of Gastroenterology and Hepatology, Endoscopy Unit, Galdakao-Usansolo Hospital, Galdakao, Bizkaia †Endoscopy Unit, Clínica Dr V. San Sebastián ‡Department of Gastroenterology and Hepatology, Endoscopy Unit, Basurto Hospital, Bilbao, Bizkaia §Department of Applied Mathematics, Statistics and Operational Research, Universidad del Pais Vasco, UPV/EHU, Leiona, Spain.
Aitor
A
Orive-Calzada
Ángel
Á
Calderón-García
Antonio
A
Bernal-Martínez
Ana B
AB
Díaz-Roca
Irantzu
I
Barrio-Beraza
Jose L
JL
Cabriada-Nuño
Victor M
VM
Orive-Cura
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004937:Esophageal Fistula / Q000601:surgery*; D004939:Esophageal Perforation / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005548:Foreign-Body Migration / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome