Original article
Clinical endoscopy
Treatment of esophageal leaks, fistulae, and perforations with temporary stents: evaluation of efficacy, adverse events, and factors associated with successful outcomes

https://doi.org/10.1016/j.gie.2013.08.039Get rights and content

Background

Factors associated with successful endoscopic therapy with temporary stents for esophageal leaks, fistulae, and perforations (L/F/P) are not well known.

Objectives

To evaluate the safety, efficacy, and outcomes of esophageal stenting in these patients and identify factors associated with successful closure.

Design

Retrospective.

Setting

Academic tertiary referral center.

Patients

All patients with attempted stent placement for esophageal L/F/P between January 2003 and May 2012.

Intervention

Esophageal stent placement and removal.

Main Outcome Measurements

Factors predictive of therapeutic success defined as complete closure after index stent removal (primary closure) or after further endoscopic stenting (secondary closure).

Results

Sixty-seven patients with 132 attempted stents for esophageal L/F/P were considered; 13 patients were excluded. Among the remaining 54 patients, 117 stents were placed for leaks (29 patients; 64 stents), fistulae (15 patients; 36 stents), and perforations (10 patients; 17 stents). Procedural technical success was achieved in all patients (100%). Primary closure was successful in 40 patients (74%) and secondary closure in an additional 5 (83% overall). On short-term (<3 months) follow-up, 27 patients (50%) were asymptomatic, whereas 22 (41%) had technical adverse events, including stent migration in 15 patients (28%). Factors associated with successful primary closure include a shorter time between diagnosis of esophageal L/F/P and initial stent insertion (9.03 vs 22.54 days; P = .003), and a smaller luminal opening size (P = .002).

Limitations

Retrospective, single-center study.

Conclusions

Temporary stents are safe and effective in treating esophageal L/F/P. Defect opening size and time from diagnosis to stent placement appear to be candidate predictors for successful closure.

Section snippets

Study design and patient selection

This retrospective, single-center study was approved by the Institutional Review Board at Indiana University Medical Center. The Indiana University Hospital endoscopic database was queried for all patients (aged ≥ 18 year old) who had stent placement for esophageal or gastroesophageal junction (GEJ) leaks (postoperative dehiscence), fistulae (benign or malignant, infectious or inflammatory), and perforations (iatrogenic or spontaneous) between January 2003 and May 2012. Patients with L/F/P

Results

Sixty-seven patients with 132 attempted stents placed for L/F/P at the esophagus or GEJ were initially considered for the study. Thirteen patients (11 fistulae, 1 leak, and 1 perforation) were excluded for the following reasons: (1) 5 returned to their referring physicians after stent placement and were lost to follow-up; (2) 6 died of non-stent–related causes (5 patients [3 with fistulae, 1 with a leak, and 1 with a perforation] died from sepsis and/or multiorgan failure and in whom stent

Discussion

Surgical management of esophageal L/F/P is associated with significant morbidity and mortality. Therefore, temporary esophageal stents have been increasingly used as a minimally invasive alternative despite a lack of clearance by the U.S. Food and Drug Administration for this indication.1, 2 This study expands the growing literature on the use of temporary stents for these conditions and summarizes our single-center experience treating a heterogeneous group of patients.

We found that in patients

References (24)

  • D. Schubert et al.

    Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents

    Gastrointest Endosc

    (2005)
  • P.G. van Boeckel et al.

    Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks

    BMC Gastroenterol

    (2012)
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    DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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