An Assessment of the Optimal Time for Removal of Esophageal Stents Used in the Treatment of an Esophageal Anastomotic Leak or Perforation.

Abstract

BACKGROUND:

Esophageal stent for the treatment of a perforation or anastomotic leak has been shown to be effective and safe. However, the optimal timing for stent removal is in question. This purpose of this investigation was to identify a time for stent removal in patients treated for an acute perforation or anastomotic leak that resulted in sealing of the leak while minimizing the incidence of stent-related complications.

METHODS:

Patients undergoing esophageal stent placement for the treatment of an acute perforation or intrathoracic anastomotic leak were identified from a single institution's prospectively collected database. Patient outcomes were recorded and analyzed. Complications were segregated by stent dwell time.

RESULTS:

During the study period, 162 patients underwent esophageal stent placement for an acute perforation (n = 117) or anastomotic leak (n = 45). Patients whose stent was removed in less than 28 days after placement for an acute perforation realized a stent complication rate that was independently reduced by 39% (odds ratio, 0.61; 95% confidence interval, 0.54 to 0.78; p < 0.01), whereas patients whose stent was removed in less than 14 days after placement for an acute perforation realized a stent complication rate that was independently reduced by 56% (odds ratio, 0.44; 95% confidence interval, 0.38 to 0.69; p < 0.001).

CONCLUSIONS:

Endoluminal esophageal stent placement is a safe and effective treatment for patients with an acute esophageal perforation or intrathoracic anastomotic leak after esophagectomy. Removal of stents at 2 weeks for anastomotic leak or 4 weeks for perforation has the potential to significantly decrease the incidence of complications associated with stent use.

• Authors: Richard K Freeman, Anthony J Ascioti, Megan Dake, Raja S Mahidhara
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 100 Issue 2 Pg. 422-8 (Aug 2015) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 26116482 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Anastomotic Leak (surgery)
• Device Removal (standards)
• Esophageal Perforation (surgery)
• Esophagus (surgery)
• Humans
• Middle Aged
• Retrospective Studies
• Stents
• Time Factors
• Young Adult