Medical Surgical Department of Gastroenterology, Hepato-Pancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Gastrointest Endosc. 2011 May;73(5):890-9. doi: 10.1016/j.gie.2010.12.019.
Self-expandable metal stents (SEMSs) have been suggested for the treatment of benign upper GI leaks and perforations. Nevertheless, uncomplicated removal remains difficult. Placement of a self-expandable plastic stent (SEPS) into an SEMS can facilitate retrieval.
This study reviews our experience with sequential SEMS/SEPS placement in patients with benign upper GI leaks or perforations.
A retrospective review of the chart of each patient who underwent SEMS placement for benign upper GI leaks or perforations, including (1) fistula after bariatric surgery, (2) other postoperative fistulae, (3) Boerhaave syndrome, (4) iatrogenic perforations, and (5) other perforations.
Single, tertiary center.
Eighty-eight patients (37 male, average age 51.6 years, range 18-89 years).
SEMS placement and removal, with or without SEPS placement.
Feasibility of SEMS removal and successful treatment of lesions and short-term and long-term complications.
A total of 153 SEMSs were placed in 88 patients; all placements were successful. Six patients died (not SEMS-related deaths) and 6 patients were lost to follow-up with SEMSs still in place. Seventy-three of the remaining 76 patients had successful SEMS removal (96.1%). The rate of successful SEMS removal per stent was 97.8% (132/135). Resolution of leaks and perforations was achieved in 59 patients (77.6%) with standard endoscopic treatment, and in 64 patients (84.2%) after prolonged, repeated endoscopic treatment. Spontaneous migration occurred in 11.1% of stents, and there were minor complications (dysphagia, hyperplasia, rupture of coating) in 20.9% and major complications (bleeding, perforation, tracheal compression) in 5.9%.
Retrospective design and highly selected patient population.
Use of SEMSs for the treatment of benign upper GI leaks and perforations is feasible, relatively safe, and effective, and SEMSs can be easily removed 1 to 3 weeks after SEPS insertion. Leaks and perforations were closed in 77.6% of cases.
自膨式金属支架（SEMS）已被建议用于治疗良性上胃肠道漏和穿孔。然而，单纯的取出仍然很困难。将自膨式塑料支架（SEPS）放置在 SEMS 内可以方便地取出。
本研究回顾了我们在良性上胃肠道漏或穿孔患者中使用序贯 SEMS/SEPS 放置的经验。
对每个因良性上胃肠道漏或穿孔而接受 SEMS 放置的患者的图表进行回顾性分析，包括（1）减肥手术后的瘘管，（2）其他术后瘘管，（3）Boerhaave 综合征，（4）医源性穿孔，和（5）其他穿孔。
单一的三级中心。
88 例患者（37 例男性，平均年龄 51.6 岁，范围 18-89 岁）。
SEMS 放置和取出，有或没有 SEPS 放置。
SEMS 取出的可行性和病变的成功治疗以及短期和长期并发症。
共放置 153 个 SEMS 于 88 例患者；所有放置均成功。6 例患者死亡（与 SEMS 无关的死亡），6 例患者失访，SEMS 仍在位。其余 76 例患者中的 73 例成功取出 SEMS（96.1%）。每个支架的 SEMS 取出成功率为 97.8%（132/135）。59 例患者（77.6%）经标准内镜治疗、64 例患者（84.2%）经延长、反复内镜治疗后漏和穿孔得到解决。支架自发迁移发生率为 11.1%，并发症发生率为 20.9%（吞咽困难、增生、涂层破裂）和 5.9%（出血、穿孔、气管压迫）。
回顾性设计和高度选择的患者人群。
SEMS 用于治疗良性上胃肠道漏和穿孔是可行的、相对安全和有效的，并且在 SEPS 插入后 1 至 3 周可以很容易地取出 SEMS。77.6%的病例漏和穿孔得到了闭合。
