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  • Title: Proximal-releasing stent insertion under transnasal endoscopic guidance in patients with postoperative esophageal leakage.
    Author: Lee KM, Shin SJ, Hwang JC, Yoo BM, Cheong JY, Lim SG, Kim JK, Cho YK, Han SU, Lee SR, Kim JH.
    Journal: Gastrointest Endosc; 2010 Jul; 72(1):180-5. PubMed ID: 20546733.
    Abstract:
    BACKGROUND: Covered metallic or plastic stent placement has become an important treatment for postoperative esophageal leakage; however, fluoroscopic guidance is also required. Here we present a novel stent insertion technique with a newly designed proximal-releasing, self-expanding metallic stent (PR-SEMS) and transnasal endoscope that can enable stent insertion without fluoroscopy as a new method to prevent stent migration. OBJECTIVE: To describe our experience with 7 patients who underwent PR-SEMS insertion with the direct-vision technique and our use of the transnasal endoscope without fluoroscopy. DESIGN: Prospective outcome study. SETTING: A tertiary-care referral university hospital. PATIENTS: This study involved all patients at our center who experienced postoperative esophageal leakage after esophagectomy, primary closure, or total gastrectomy. INTERVENTION: PR-SEMS insertion with the direct vision technique and use of transnasal endoscopy without fluoroscopy. MAIN OUTCOME MEASUREMENTS: Success rate of stent insertion, healing rate of postoperative esophageal leaks, and stent migration rate. RESULTS: All stents were placed at the expected location without complications. One patient had massive hematemesis and underwent surgery. The bleeding focus was the splenic artery, which was damaged during gastrectomy. A significant marginal ulcer occurred in one patient, and the stent was immediately retrieved with an endoscope. After stent removal, 4 postoperative leakages were completely healed, and 2 lesions were not occluded. The 2 remaining minimal lesions became completely occluded with conservative management after stent removal. Stent migration did not occur. LIMITATIONS: A small number of patients. Further prospective, randomized, controlled trials are needed. CONCLUSION: PR-SEMS insertion under transnasal endoscopic guidance is a feasible, safe, and effective treatment for postoperative esophageal leakage, and it can be performed as a bedside procedure. Our anchoring method is effective for the prevention of migration from nonobstructed lesions.
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