Self-expandable metal stent placement for closure of a leak after total gastrectomy for gastric cancer: report on three cases and review of the literature.
In the setting of the curative oncological surgery, the gastric surgery is exposed to complicated upper gastrointestinal leaks, and consequently the management of this problem has become more critically focused than was previously possible. We report here three cases of placement of a partially silicone-coated SEMS (Evolution Controlled Release Esophageal Stent System, Cook Medical, Winston-Salem, NC, USA) in patients who underwent total gastrectomy with Roux-en-Y end-to-side esophagojejunostomy for a gastric adenocarcinoma. The promising results of our report, despite the small number of patients, suggest that early stenting (through a partially silicone-coated SEMS) is a feasible alternative to surgical treatment in this subset of patients. In fact, in the treatment of leakage after total gastrectomy, plastic stents and totally covered metallic stents may not adhere sufficiently to the esophagojejunal walls and, as a result, migrate beyond the anastomosis. However, prospective studies with a larger number of patients might assess the real effectiveness and safety of this procedure.
Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele-G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy.
Dario
D
Raimondo
Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele-G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy ; Ph.D. Course in Surgical Biotechnology and Regenerative Medicine, University of Palermo, Piazza delle Cliniche 2, 90100 Palermo, Italy ; Euro-Mediterranean Institute of Science and Technology (IEMEST), Via Emerico Amari 123, 90100 Palermo, Italy.
Emanuele
E
Sinagra
Surgery Unit, Fondazione Istituto San Raffaele-G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy.
Tiziana
T
Facella
Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele-G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy.
Francesca
F
Rossi
Oncology Unit, Fondazione Istituto San Raffaele-G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy.
Marco
M
Messina
Oncology Unit, Fondazione Istituto San Raffaele-G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy.
Massimiliano
M
Spada
Surgery Unit, Fondazione Istituto San Raffaele-G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy.
Guido
G
Martorana
Surgery Unit, Fondazione Istituto San Raffaele-G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy.
Pier Enrico
PE
Marchesa
Internal Medicine Unit, Fondazione Istituto San Raffaele-G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy.
Rosario
R
Squatrito
Euro-Mediterranean Institute of Science and Technology (IEMEST), Via Emerico Amari 123, 90100 Palermo, Italy ; Department of Surgical and Oncological Disciplines, University of Palermo, Piazza delle Cliniche 2, 90100 Palermo, Italy.
Giovanni
G
Tomasello
Department of Surgical and Oncological Disciplines, University of Palermo, Piazza delle Cliniche 2, 90100 Palermo, Italy.
Attilio Ignazio
AI
Lo Monte
Pathology Unit, Fondazione Istituto San Raffaele-G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy.
Giancarlo
0000-0001-6729-4750
G
Pompei
Internal Medicine Unit, Fondazione Istituto San Raffaele-G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy ; Unità Operativa di Medicina Interna e Trapiantologia, Ospedale San Raffaele, Via Olgettina 60, Milano, Italy.
Ennio
E
La Rocca