Aryaie Amir H, Singer Jordan L, Fayezizadeh Mojtaba, Lash Jon, Marks Jeffrey M
Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
Surg Endosc. 2017 Feb;31(2):612-617. doi: 10.1007/s00464-016-5005-8. Epub 2016 Jun 17.
Anastomotic or staple-line leak after foregut surgery presents a formidable management challenge. In recent years, with advancement of endoscopy, self-expanding covered stents have been gaining popularity. In this study, we aimed to determine the safety and effectiveness of self-expanding covered stents in management of leak after foregut surgery.
Consecutive patients who received a fully covered self-expandable metal stent (SEMS) due to an anastomotic leak after upper gastrointestinal surgery between 2009 and 2014 were retrospectively reviewed. Demographic data, stent placement and removal, clinical success, time to resolution, and complications were collected. Predictive factors for clinical success rate were assessed.
A total of 20 consecutive patients underwent placement of fully covered SEMS for anastomotic leak, following esophagectomy (n = 5), esophageal diverticulectomy (n = 1), gastric sleeve (n = 4), gastric bypass (n = 3), partial gastrectomy (n = 4), and total gastrectomy (n = 3). All the stents were removed successfully, and clinical resolution was achieved in 18 patients (90 %) after a median of two (range 1-3) procedures and a mean of 6.2 weeks (range 0.4-14). Complications presented in 12 patients (60 %), including stent migration (n = 8), mucosal friability (n = 4), tissue integration (n = 2), and bleeding (n = 2). Two (10 %) patients' treatment was complicated by aorto-esophageal fistula formation resulting in one death. Demographic factors, comorbidities, and type of surgery were not predictive of clinical success rate or time to resolution.
SEMS are effective tools for the management of leaks after foregut surgery. The biggest challenge with this approach is stent migration. Caution is warranted due to the risk of fatal complications such as aorto-esophageal fistula formation. No type of surgery or particular patient factor, including age, sex, BMI, albumin, history of radiation, malignancy, and comorbid diabetes or coronary artery disease, appeared to be correlated with success rate. Larger studies are needed to determine factors predictive of clinical success.
前肠手术后吻合口漏或吻合钉线漏是一个严峻的管理挑战。近年来，随着内镜技术的进步，自膨式覆膜支架越来越受欢迎。在本研究中，我们旨在确定自膨式覆膜支架在前肠手术后漏口管理中的安全性和有效性。
回顾性分析2009年至2014年间因上消化道手术后吻合口漏而接受全覆膜自膨式金属支架（SEMS）治疗的连续患者。收集人口统计学数据、支架置入和取出情况、临床成功率、漏口愈合时间及并发症。评估临床成功率的预测因素。
共有20例连续患者因吻合口漏接受了全覆膜SEMS置入，其中食管切除术后5例、食管憩室切除术后1例、胃袖状切除术后有4例、胃旁路术后3例、胃部分切除术后4例、胃全切除术后3例。所有支架均成功取出，18例（90%）患者在中位2次（范围1 - 3次）操作和平均6.2周（范围0.4 - 14周）后临床症状缓解。12例（60%）患者出现并发症，包括支架移位8例、黏膜脆性增加4例、组织粘连2例和出血2例。2例（10%）患者的治疗因形成主动脉 - 食管瘘而复杂化，导致1例死亡。人口统计学因素、合并症和手术类型均不能预测临床成功率或漏口愈合时间。
SEMS是前肠手术后漏口管理的有效工具。这种方法最大的挑战是支架移位。由于存在诸如主动脉 - 食管瘘形成等致命并发症的风险，因此需要谨慎。未发现任何手术类型或特定患者因素，包括年龄、性别、体重指数、白蛋白、放疗史、恶性肿瘤以及合并糖尿病或冠状动脉疾病，与成功率相关。需要进行更大规模的研究来确定预测临床成功的因素。
