Guilherme F Gomes, Dr, Renato Vianna Soares, Dr, Eduardo Aimore Bonin, Dr, Rafael W Noda, Dr. Hospital NS das Gracas
INTRODUCTION: The use of covered metal stents (SEMS) has emerged as a valuable option in the management of patients with gastrointestinal leaks. In Brazil, due to high costs and relatively low availability and expertise, the use off SEMS is still uncommon. While traditional surgical management remain the standard of care in Brazil, patients referred for endoscopic treatment are usually in poor clinical condition and have complex large fistulas. We present our experience in the use of SEMS for gastrointestinal leaks in an emerging country environment.
METHODS AND PROCEDURES: From 2009 and 2016, 12 consecutive patients with complex post-surgical GI fistulas were treated with SEMS in a single center. Data on demographics, location of the leak and outcomes were captured prospectively in a database and retrospectively analyzed.
RESULTS: Two patients (16.67%) were treated with fully covered stent and 10 had partially covered stent. The mean age was 55,6 years old. Seven patients were male and five were female. The index operation were: an esophagectomy in five patients (41.67%) with a post-operative gastroesophageal leak; three patients (25%) had a RYGB with a leaking gastrojejunostomy (including one patient with also a leak from the angle of His); one patient had a resection of an epiphrenic diverticulum and had a staple line leak (8.3%); one patient (8,3%) had a leiomyoma resection with an postoperative esophageal leak; two patients (16.7%) had a low anterior resection of the rectum with postoperative colorrectal leak. All but one leak eventually closed (91,67%) with an average time for closure of 6.2 weeks after SEMS placement . One patient (8.3%) required surgical repair. Stent migration occurred in one patient with a fully covered stent. A second stent was placed in 2 patients (16.7%) due to persistent leak. One patient had also a collagen plug. Other adverse effects were: severe mucosal avulsion upon retrieval with stenosis requiring dilatations in one patient and gastric perforation at the distal edge of the stent in 1 patient.
CONCLUSIONS: Self-expanding metal stent is an acceptable option for the treatment of life-threatening large gastrointestinal post-operative leaks, but complications due to stenting are not infrequent.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80659
Program Number: P350
Presentation Session: Poster (Non CME)
Presentation Type: Poster
