Abstract

OLIVEROS WILCHES, Ricardo; PINILLA MORALES, Raúl; CONTRERAS PARRA, Haylmanrth  and  GUEVARA CRUZ, Oscar. The Use of Self-expanding Metal Stents to Manage Fistulas of Esophageal Intestinal Anastomosis in Patients with Cancer. Rev Col Gastroenterol [online]. 2014, vol.29, n.3, pp.285-295. ISSN 0120-9957.

Objective: The objective of this study is to show our experience in the management of patients with dehiscence of jejunal-esophageal or esophageal-gastric anastomoses through the use of esophageal self-expanding stents. Materials and Methods: During 2012 and 2013 all complications following gastrectomies in gastric cancer patients with anastomoses were recorded. Only patients with dehiscence or anastomotic leaks were included in this study. An information form was used to record each patient’s age, sex, location of lesion, medical condition, whether nutritional repletion had been received, whether patient had undergone chemotherapy or radiation therapy, date of presentation of the fistula or dehiscence, measurements of size, type of management used, mortality, stent used, number of stents used, stent migration and stent removal. Results: Six patients, four men and two women, five of whom had abdominal dehiscence and one who had thoracic dehiscence, were included. They had five gastric adenocarcinomas and one gastric GIST with liver metastasis. Two had received nutritional repletion because they had lost 10% of their body weight. All patients were had their anastomoses stapled. Five patients underwent radiological studies with water-soluble contrast which confirmed dehiscence in three of them. All patients were managed with surgical re-exploration and drainage. Only two patients had their stents replaced during surgery which were required because of stent migration. Migration was observed in 50% of these patients. The longest hospital stay was 68 days. Two patients (33%) died, one had a chronic fistula managed with two prostheses and the other died on same day as his second surgical intervention. Stents were removed after the fourth week. Conclusions: The frequency of this complication varies from 0% to 30%. Early recognition and appropriate management are essential when faced with this complication. A few years ago this complication was almost exclusively managed by surgery and re-intervention was the rule. Currently, management of this complication is controversial, and there are no definitive guidelines. Nevertheless, the approach and management depends on the clinical condition of the patient, the size of the dehiscence, and the vitality of the edges of the complication. The tendency is to try to preserve continuity. Intestinal endoscopy is used for diagnosis and the complication is managed with a series of new tools among which the most frequently used are self-expanding metal prosthesis

Keywords : Anastomotic leak; anastomotic leakage; gastrectomy; esophagectomy; management; self-expanding metal stents.

        · abstract in Spanish     · text in English | Spanish     · English ( pdf ) | Spanish ( pdf )