Endoscopic therapy for esophageal perforation or anastomotic leakage with a self expandable metallic stent

Introduction
Leakage of the esophagus is associated with a high mortality rate and needs to be treated as soon as possible. Therapeutic options are either surgical or conservative. We evaluated the treatment of esophageal leaks with self expandable metallic stents (SEMS).
Methods
Between 2002 and 2005, we included 24 consecutive patients for iatrogenic esophageal perforation (n=11), intrathoracic anastomotic leakage after esophagectomy (n=10), and spontaneous tumor peforation (n=3) in our study. All patients were treated with endoscopic placement of a covered SEMS. Stent removal was performed 4 to 6 weeks after implantation. To exclude continuous esophageal leakage, radiologic examination was performed after stent implantation and removal.
Results:
In all patients, a stent could successfully be placed and postinterventional x-ray demonstrated full coverage of the leakage. After 4 to 6 weeks, complete closure of the esophageal leak could be achieved in 22 patients (92%). One patient died after stent implantation due to myocardial infarction. The second patient with spontaneous tumor perforation received neoadjuvant therapy and underwent esophagectomy with gastric pull-up. Stent migration was not seen.
Conclusions:
Implantation of covered self expandable metallic stents in patients with esophageal leakage is a successful alternative for operative treatment and can lower the morbidity rate.

Session: Podium Presentation

Program Number: S006