title: Self-expanding metal stents in postoperative esophageal leaks.
abstract: BACKGROUND
  Postoperative esophageal leaks have a high morbidity and mortality. Self-expanding metal stents (SEMS) have been used as an alternative to re-operation.
  
  
  OBJECTIVE
  Evaluating predictors of success of SEMS in postoperative esophageal leaks.
  
  
  METHODS
  Retrospective study of patients with postoperative esophageal leaks referred for SEMS placement in a reference center during a period of 3 years. Technical success was defined as closure of the leak in barium swallow at 15 days. Clinical success was considered as endoscopic and/or radiographic confirmation of closure after stent removal.
  
  
  RESULTS
  Thirteen patients placed SEMS. Median follow-up was 58 days. Leaks had a median size of 20 mm. Time between surgery and SEMS placement was 20 days. One patient died 2 days after SEMS placement and one had worsening of the fistula after SEMS expansion. Time till stent migration was 9 days. Technical success was achieved in 9 of 11 patients, with clinical success without recurrence in 5 patients. All leaks with less than 20 mm were solved endoscopically. Technical and clinical success was higher when time between surgery and SEMS placement was lower, even though without statistical significance (respectively, p = 0.228 and 0.374). In the 8 patients who died during follow-up, median survival was 59 days.
  
  
  CONCLUSIONS
  Technical success of SEMS was higher than 80%; however, due to high morbidity and mortality, only 45% of patients had their stent removed. Lower time from diagnosis to SEMS placement and leak size less than 20 mm may be associated with better results.
authors.affiliation: Gastroenterology, Centro Hospitalar São João, Portugal.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Rodrigues-Pinto
authors.affiliation: Gastroenterology, Centro Hospital São João, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Pereira
authors.affiliation: Gastroenterology, Centro Hospitalar São João, Portugal.
authors.forename: Armando
authors.initials: A
authors.lastname: Ribeiro
authors.affiliation: Gastroenterology, Centro Hospitalar São João, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Moutinho-Ribeiro
authors.affiliation: Gastroenterology, Centro Hospitalar S. João, Portugal.
authors.forename: Susana
authors.initials: S
authors.lastname: Lopes
authors.affiliation: Gastroenterology, Centro Hospitalar S. João, Portugal.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Macedo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000628:therapy*; D001466:Barium Sulfate; D004937:Esophageal Fistula / Q000209:etiology / Q000628:therapy; D004939:Esophageal Perforation / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D014965:X-Rays; D055815:Young Adult
chemical_list: D001466:Barium Sulfate