Double Layer Stent for the Treatment of Leaks and Fistula After Upper Gastrointestinal Oncologic Surgery: A Retrospective Study

Aims Anastomotic dehiscence is one of the most morbidity related and deadly complication after foregut oncologic surgery. The use of self-expanding metal stents (SEMS) has been found effective for the treatment of esophageal post-surgical leaks or fistula. The aim of the study is to evaluate the effectiveness of double layer stents (Niti-S Beta Esophageal Stent) in the management of dehiscences after upper gastrointestinal oncologic surgery.

Methods We retrospectively studied consecutive patients who underwent Niti-S Beta Esophageal Stent placement from June 2014 to September 2019 for the treatment of anastomotic leaks/fistula following esophagectomy or gastrectomy for cancer. Data were collected in a dedicated database including patients’ characteristics. Univariate 2-sided logistic regression analysis was used to evaluate possible predictors successful anastomotic leak/fistula closure. Data were analysed with Medcalc software (MedCalc Software Ltd, Ostend, Belgium).

Results A total of 37 patients were studied and 75 stents were positioned in these patients during the endoscopic procedures. Effective leak/fistula closure was obtained in 23/37 (62.2 %). No technical endoscopic failure or complications ensued during the placing of the devices. Regarding delayed complications, migration was observed in 17/75 (22.7 %) procedures and stent leaking in 29/75 (38.6 %).

Three variables significantly favoured stent treatment failure, namely previous neoadjuvant therapy (OR = 9.3 - P = 0.01), fistula (instead of leak) (OR = 6.5 - P = 0.01), and stent leak (OR = 17.0 - P = 0.01).

Conclusions Placement of Beta Niti-S Esophageal stent is a safe and effective method that could be considered for the management of leaks and fistula after upper gastrointestinal for cancer. Crucial points in the management of post-surgical leaks with this technique are the prompt recognition of leaks and fistula, the prompt endoscopic/radiologic drain of collection and the choice of adequate size of the stent.

Citation: Mandarino FV,Esposito D, Spelta G et al. eP29 DOUBLE LAYER STENT FOR THE TREATMENT OF LEAKS AND FISTULA AFTER UPPER GASTROINTESTINAL ONCOLOGIC SURGERY: A RETROSPECTIVE STUDY. Endoscopy 2021; 53: S107.

Publication History

Article published online:
19 March 2021