title: An Assessment of the Optimal Time for Removal of Esophageal Stents Used in the Treatment of an Esophageal Anastomotic Leak or Perforation.
abstract: BACKGROUND
  Esophageal stent for the treatment of a perforation or anastomotic leak has been shown to be effective and safe. However, the optimal timing for stent removal is in question. This purpose of this investigation was to identify a time for stent removal in patients treated for an acute perforation or anastomotic leak that resulted in sealing of the leak while minimizing the incidence of stent-related complications.
  
  
  METHODS
  Patients undergoing esophageal stent placement for the treatment of an acute perforation or intrathoracic anastomotic leak were identified from a single institution's prospectively collected database. Patient outcomes were recorded and analyzed. Complications were segregated by stent dwell time.
  
  
  RESULTS
  During the study period, 162 patients underwent esophageal stent placement for an acute perforation (n = 117) or anastomotic leak (n = 45). Patients whose stent was removed in less than 28 days after placement for an acute perforation realized a stent complication rate that was independently reduced by 39% (odds ratio, 0.61; 95% confidence interval, 0.54 to 0.78; p < 0.01), whereas patients whose stent was removed in less than 14 days after placement for an acute perforation realized a stent complication rate that was independently reduced by 56% (odds ratio, 0.44; 95% confidence interval, 0.38 to 0.69; p < 0.001).
  
  
  CONCLUSIONS
  Endoluminal esophageal stent placement is a safe and effective treatment for patients with an acute esophageal perforation or intrathoracic anastomotic leak after esophagectomy. Removal of stents at 2 weeks for anastomotic leak or 4 weeks for perforation has the potential to significantly decrease the incidence of complications associated with stent use.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, St. Vincent Hospital, Indianapolis, Indiana. Electronic address: richard.freeman@stvincent.org.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Freeman
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, St. Vincent Hospital, Indianapolis, Indiana.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Ascioti
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, St. Vincent Hospital, Indianapolis, Indiana.
authors.forename: Megan
authors.initials: M
authors.lastname: Dake
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, St. Vincent Hospital, Indianapolis, Indiana.
authors.forename: Raja S
authors.initials: RS
authors.lastname: Mahidhara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000601:surgery*; D020878:Device Removal / Q000592:standards*; D004939:Esophageal Perforation / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D055815:Young Adult