Endoscopic stents in the management of anastomotic complications after foregut surgery: new applications and techniques.
BACKGROUND
Anastomotic complications after foregut surgery include leaks, fistulas, and late strictures. The management of these complications can be challenging, and it may be desirable to avoid complex reoperation.


OBJECTIVE
We aim to describe the indications and outcomes of the use of esophageal self-expanding metal stents in the management of postoperative anastomotic complications after foregut surgery.


METHODS
Tertiary-referral academic medical center.


METHODS
We performed a retrospective review of a prospectively managed database. Data was collected on patient demographic characteristics, work-up, intraprocedure findings, and outcomes.


RESULTS
From October of 2009 to November of 2014, 47 patients (mean age 51.1, 36 women and 11 men) underwent endoscopic stent placement for anastomotic complications following upper gastrointestinal (UGI) surgery. The median time from index operation to endoscopic stent placement was 52 days (range 1-5280 days). Indications were sleeve leak or stenosis, gastrojejunal leak or stenosis after Roux-en-Y gastric bypass (RYGB), pouch staple-line leak after RYGB, enterocutaneous fistula, perforation after endoscopic dilation, upper gastrointestinal bleeding after peroral endoscopic myotomy (POEM), and peptic stricture after POEM. Symptomatic improvement occurred in 76.6% of patients, and early oral intake was initiated in 66% of patients. 14 patients (29.8%) went on to require definitive surgical intervention for persistent symptomatology. The average follow-up was 354.1 days (range 25-1912 days).


CONCLUSIONS
This paper describes the use of endoscopic stent therapy for a variety of pathologies after upper gastrointestinal surgery. We demonstrate that, in the appropriate setting, it is an effective and less-invasive therapeutic approach.
Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: juliettac@gmail.com.
Julietta
J
Chang
Cleveland Clinic Foundation, Cleveland, Ohio.
Gautam
G
Sharma
Cleveland Clinic Foundation, Cleveland, Ohio.
Mena
M
Boules
Cleveland Clinic Foundation, Cleveland, Ohio.
Stacy
S
Brethauer
Cleveland Clinic Foundation, Cleveland, Ohio.
John
J
Rodriguez
Cleveland Clinic Foundation, Cleveland, Ohio.
Matthew D
MD
Kroh
D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery; D050110:Bariatric Surgery / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D005773:Gastroscopy / Q000379:methods*; D059685:Herniorrhaphy / Q000379:methods; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
Bariatric surgery; Endoscopic surgery; Foregut surgery; Postoperative complications; Stenting; Therapeutic endoscopy