|
Back to Annual Meeting Program
Fully Covered Self Expanding Removable Metal Stents Are Effective for Esophageal Fistulas, Leaks, Perforations and Benign Strictures
Jennifer L. Kramer*, Alexander S. Farivar, Eric VallièRes, Ralph W. Aye, Brian E. Louie
Swedish Medical Center and Cancer Institute, Seattle, WA
Purpose: Expandable plastic stents are the only stent approved for benign esophageal disease. However these stents are prone to migration and inadequate leak control. The self-expanding design of fully covered metal stents (CS), approved for malignancy only, is ideally suited for benign esophageal disease. Not only are they removable, but the continued radial force may reduce migration, result in durable stricture resolution and effect control of fistulas, leaks and perforations. We reviewed our experience with CS in 2 groups: benign strictures and fistulas/leaks/perforations to evaluate our outcomes and define the role of CS in the treatment algorithms these complex problems.
Methods: Chart review of all stents inserted for fistulas, leaks, perforations, and benign strictures from 2005 to 2011.
Results: A total of 56 CS were placed in 39 patients. Indications were stricture (14), anastomotic leak (12), perforation (4), staple line leak (4), fistulas (4) and other (1). There was no procedural mortality. There were complications in 32%: 10 stent migrations, 3 upper GI bleeds, 4 impactions and 1 erosion.
Benign Stricture Group:
Strictures had been previously dilated a median of 2.5 times prior to stenting in 13/14 patients. Stents were removed at a mean of 25 days. At a mean of 219 days of follow up, strictures remained patent. Eleven patients were managed with a single stent but 3 patients required sequentially larger stents to achieve patency. Adjunctive intralesional steroids were used in 11/14 patients.
Fistula/Leak/Perforation Group:
Control of the disruption was achieved in 79% of patients with fistulas (3/4), leaks (12/16) and perforations (4/4), but needed to be combined with drainage, VATS or laparoscopy in 12/24 leaks. All disruptions healed but 13/24 had to remain NPO during this time. Stents were removed at a mean of 42 days in this group.
Conclusions: CS are effective in the management of benign refractory strictures, fistulas, leaks, and perforations. A CS with intralesional steroids is an alternative to serial dilations for stricture. Whereas fistulas, leaks and perforations when combined with minimally invasive drainage, may avoid open repair or even salvage a prior open repair. CS are well tolerated and removable, with acceptable complication rates and have a low migration rate.
Back to Annual Meeting Program
|
