INTRODUCTION: Partially covered self-expanding metal stents (SEMS), have been suggested as an alternative to surgery in the treatment of esophageal fistulas of benign etiology. Nevertheless, uncomplicated removal remains difficult. The use of fully covered (FC) SEMSs could solve this problem. OBJECTIVES: To review our experience with FC-SEMS placement in patients with benign upper gastrointestinal leaks or perforations. We wanted to assess successful closure of the perforations and short-term and long-term complications. MATERIALS AND METHODS: Multicenter study, including 3 tertiary centers. Retrospective review of patients who underwent FC-SEMS placement for benign perforations. RESULTS: Eighty-eight stents were placed in 56 patients. We achieved leak closure in 44 patients (78.6%). There were 18 migrations. All of them could be solved endoscopically. A severe septic situation was associated with a higher mortality rate (27.6% vs. 7.4%; P=0.049) and a lower success rate (34.5% vs. 7.4%; P=0.088), compared with those patients who did not present severe sepsis. However, these differences could not be confirmed by multivariable analysis. The results in the subgroup of 11 patients with leaks after sleeve gastrectomy were also good (73% success without surgery and 0% mortality). CONCLUSIONS: Temporary placement of FC-SEMS for benign perforations, fistulas, and leaks is feasible in sealing the leaks. All migrations could be solved endoscopically. It is very important to insert the stent before sepsis is established. This article also would be an addition to the growing body of literature supporting stenting as a good alternative if not standard approach to controlling these leaks.
INTRODUCTION: Partially covered self-expanding metal stents (SEMS), have been suggested as an alternative to surgery in the treatment of esophageal fistulas of benign etiology. Nevertheless, uncomplicated removal remains difficult. The use of fully covered (FC) SEMSs could solve this problem. OBJECTIVES: To review our experience with FC-SEMS placement in patients with benign upper gastrointestinal leaks or perforations. We wanted to assess successful closure of the perforations and short-term and long-term complications. MATERIALS AND METHODS: Multicenter study, including 3 tertiary centers. Retrospective review of patients who underwent FC-SEMS placement for benign perforations. RESULTS: Eighty-eight stents were placed in 56 patients. We achieved leak closure in 44 patients (78.6%). There were 18 migrations. All of them could be solved endoscopically. A severe septic situation was associated with a higher mortality rate (27.6% vs. 7.4%; P=0.049) and a lower success rate (34.5% vs. 7.4%; P=0.088), compared with those patients who did not present severe sepsis. However, these differences could not be confirmed by multivariable analysis. The results in the subgroup of 11 patients with leaks after sleeve gastrectomy were also good (73% success without surgery and 0% mortality). CONCLUSIONS: Temporary placement of FC-SEMS for benign perforations, fistulas, and leaks is feasible in sealing the leaks. All migrations could be solved endoscopically. It is very important to insert the stent before sepsis is established. This article also would be an addition to the growing body of literature supporting stenting as a good alternative if not standard approach to controlling these leaks.
Authors: Alaa Alakkari; Ruchit Sood; Simon M Everett; Bjorn J Rembacken; Jeremy Hayden; Abeezar Sarela; Noor Mohammed Journal: Frontline Gastroenterol Date: 2019-01-12
Authors: Franck Billmann; Aylin Pfeiffer; Peter Sauer; Adrian Billeter; Christian Rupp; Ronald Koschny; Felix Nickel; Moritz von Frankenberg; Beat Peter Müller-Stich; Anja Schaible Journal: Obes Surg Date: 2021-11-03 Impact factor: 4.129