Self-Expandable Metal Stenting For Esophageal Fistula Closure: Increasing The Odds Of Success

Aims Esophageal self-expanding metal stent (SEMS) can be considered for treatment of anastomotic leaks and fistulas.

Aim To assess predictors for SEMS success in the closure of fistulas and anastomotic leaks.

Methods Retrospective cohort study, including consecutive patients submitted to esophageal stenting for fistula or anastomotic leaks closure, from 2012 to 2020. The outcome variable was fistula closure evaluated 8 weeks after stent placement. Univariate analysis tested the statistical significance towards the outcome. Logistic regression models quantified the correlation.

Results We included 30 patients, 18 (60 %) were men, and the mean age was 60 years old. We report 26 (87 %) anastomotic leaks, mainly in the post-operatory of total (n = 21) and partial gastrectomies (n = 5). Eleven gastrectomies were bariatric and 15 for gastric neoplasia. Only 4 fistulas appeared (13.3 %) in the scenario of esophageal neoplasia. Twenty-three (76.7 %) patients achieved fistula/anastomotic leak resolution. From the other 7 patients (24.6 %), 5 died after the 8-week period and 2 lost follow-up. Twenty (66 %) SEMS were partially covered, and 10 (33 %) fully covered. The “stent-in-stent” technique was performed in 10 (33 %) cases for stent removal. Minor complications occurred in 14 (46 %) cases and major complications in 1 patient (3.3 %), a case of esophageal perforation. The variables smoking (odds ratio 0.059; CI 95 % [0.006-0.594]; p value 0.016), a neoplastic cause of fistula/anastomotic leak (odds ratio 0.061; CI 95 % [0.005-0.739]; p value 0.028) and oral systemic corticotherapy (odds ratio 0,034; CI 95 % [0.003-0.416]; p value 0.008) were statistically associated with lower fistula/anastomotic leaks closure.

Conclusions Temporary esophageal SEMS placement is a safe and effective endoscopic procedure to ensure esophageal fistula/anastomotic leaks closure. Smoking, corticosteroid use and malignancy significantly decrease the odds of fistula/anastomotic leak closure. Optimizing the selection of patients for SEMS placement might increase the chances of procedure’s success.

Citation de Sousa Magalhães R, Capela T, Cúrdia Gonçalves T et al. eP339 SELF-EXPANDABLE METAL STENTING FOR ESOPHAGEAL FISTULA CLOSURE: INCREASING THE ODDS OF SUCCESS. Endoscopy 2021; 53: S208.

Publication History

Article published online:
19 March 2021