title: Double-type metallic stents efficacy for the management of post-operative fistulas, leakages, and perforations of the upper gastrointestinal tract.
abstract: BACKGROUND
  The management of post-operative anastomotic leakage and fistulas of the upper GI tract remains challenging. Fully covered stents are used despite a high risk of migration because of a better removability. The goal of our study was to evaluate the effectiveness of this new type of endoscopic stent in this indication. The secondary objective was to determine the ability of withdrawing this stent.
  
  
  METHODS
  Thirty-six patients treated for upper GI fistula using a double-type metallic stent (DTMS) (Taewoong, Korea) for a benign indication were included in this retrospective study. This stent associates an outer uncovered metallic stent, decreasing the risk of migration, to an inner fully covered stent that ensured its tightness. The DTMS was removed after 4 weeks of treatment.
  
  
  RESULTS
  Twenty-four patients had a post-operative fistula (15 sleeve gastrectomies), eight had an anastomotic leakage, and four had an esophageal perforation. Seventeen patients underwent a previous failed stenting, and fourteen had an associated treatment with OTSC clips. A final complete healing was achieved in twenty-six patients (72%). For patients with fistulas, the overall success rate was 66.6% (16/24) mostly in case of post sleeve fistula (80%), and it was 75% (6/8) for patients with anastomotic leakages (3/4). We reached a primary success (one session) in twenty-one cases (58.3%), and a second session was required in five cases. All the stents were removed without complications after a median stenting time of 32 [20-71] days. The spontaneous migration rate was 16.6%.
  
  
  CONCLUSIONS
  This new double-type stent is a new and efficient way to treat post-operative fistulas and leakages in the upper GI tract. The stents were always removable despite the external uncovered part with a low migration rate.
authors.affiliation: North Hospital, University of Mediterranean, Chemin des Bourrelys, 13915, Marseille, France, jmgonza05@yahoo.fr.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Gonzalez
authors.forename: R
authors.initials: R
authors.lastname: Garces Duran
authors.forename: G
authors.initials: G
authors.lastname: Vanbiervliet
authors.forename: V
authors.initials: V
authors.lastname: Lestelle
authors.forename: C
authors.initials: C
authors.lastname: Gomercic
authors.forename: M
authors.initials: M
authors.lastname: Gasmi
authors.forename: A
authors.initials: A
authors.lastname: Desjeux
authors.forename: J C
authors.initials: JC
authors.lastname: Grimaud
authors.forename: M
authors.initials: M
authors.lastname: Barthet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D016145:Endoscopy, Digestive System / Q000379:methods; D004937:Esophageal Fistula / Q000601:surgery*; D004939:Esophageal Perforation / Q000209:etiology / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects; D005747:Gastric Fistula / Q000601:surgery*; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D056910:Republic of Korea; D012189:Retrospective Studies; D015607:Stents; D013525:Surgical Instruments
chemical_list: D008670:Metals