Skip to main content
Springer Nature Link
Log in

Self-expanding metal stents or nonstent endoscopic therapy: which is better for anastomotic leaks after total gastrectomy?

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Anastomotic leaks are a life-threatening complication of gastrectomies with high mortality after surgical reintervention. Endoscopic therapy using fibrin glue injection, endoclip, and other devices is an alternative to surgical intervention for anastomotic leaks. Recently, self-expanding metal stents (SEMS) were introduced to treat anastomotic leaks. The purpose of this study was to assess the clinical characteristics and therapeutic outcomes of SEMS and nonstent endoscopic therapy (NSET) for treatment of anastomotic leaks after total gastrectomy with the aim of assisting endoscopists in choosing a treatment method.

Methods

Between July 2002 and March 2013, 13 patients treated with SEMS and 14 patients treated with NSET for anastomotic leaks after total gastrectomy were enrolled onto the study. Enrolled patients received 16 SEMS placement sessions and 21 NSET sessions.

Results

No significant differences in baseline characteristics or clinical characteristics related to leakage were detected in patients with SEMS compared to NSET. The successful sealing rate at the first attempt by SEMS was significantly better than that of NSET (80.0 vs. 28.6 %, P = 0.036), whereas the successful sealing rate after multiple endoscopic treatments was not statistically different (80.0 vs. 64.3 %, P = 0.653). The main reason for reintervention with SEMS was complications and with NSET was nonseal (P = 0.004). Clinical outcomes including length of hospital stay, endoscopic treatment-related mortality, and all-cause mortality were not significantly different between the 2 groups.

Conclusions

In terms of efficacy by single effort, SEMS was superior to other methods for treating anastomotic leaks after total gastrectomy. However, complications with SEMS should be considered when choosing an endoscopic treatment method.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Explore related subjects

Discover the latest articles and news from researchers in related subjects, suggested using machine learning.

Abbreviations

SEMS:

Self-expanding metal stent

NSET:

Non-stent endoscopic therapy

References

  1. Parkin DM, Bray FI, Devesa SS (2001) Cancer burden in the year 2000. The global picture. Eur J Cancer 37(Suppl 8):S4–S66

    Article  PubMed  Google Scholar 

  2. Parkin DM (2004) International variation. Oncogene 23(38):6329–6340

    Article  CAS  PubMed  Google Scholar 

  3. Zilberstein B, da Costa MartinsB, Jacob CE, Bresciani C, Lopasso FP, de Cleva R, Pinto Junior PE, Junior UR, Perez RO, Gama-Rodrigues J (2004) Complications of gastrectomy with lymphadenectomy in gastric cancer. Gastric Cancer 7(4):254–259

    Article  PubMed  Google Scholar 

  4. Park DJ, Lee HJ, Kim HH, Yang HK, Lee KU, Choe KJ (2005) Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg 92(9):1099–1102

    Article  CAS  PubMed  Google Scholar 

  5. Marrelli D, Pedrazzani C, Neri A, Corso G, DeStefano A, Pinto E, Roviello F (2007) Complications after extended (D2) and superextended (D3) lymphadenectomy for gastric cancer: analysis of potential risk factors. Ann Surg Oncol 14(1):25–33

    Article  PubMed  Google Scholar 

  6. Nieminen A, Kokkola A, Yla-Liedenpohja J, Louhimo J, Mustonen H, Puolakkainen P (2009) Early gastric cancer: clinical characteristics and results of surgery. Dig Surg 26(5):378–383

    Article  CAS  PubMed  Google Scholar 

  7. Pickleman J, Watson W, Cunningham J, Fisher SG, Gamelli R (1999) The failed gastrointestinal anastomosis: an inevitable catastrophe? J Am Coll Surg 188(5):473–482

    Article  CAS  PubMed  Google Scholar 

  8. Oh SJ, Choi WB, Song J, Hyung WJ, Choi SH, Noh SH (2009) Complications requiring reoperation after gastrectomy for gastric cancer: 17 years experience in a single institute. J Gastrointest Surg 13(2):239–245

    Article  PubMed  Google Scholar 

  9. Rodella L, Laterza E, De Manzoni G, Kind R, Lombardo F, Catalano F, Ricci F, Cordiano C (1998) Endoscopic clipping of anastomotic leakages in esophagogastric surgery. Endoscopy 30(5):453–456

    Article  CAS  PubMed  Google Scholar 

  10. Truong S, Bohm G, Klinge U, Stumpf M, Schumpelick V (2004) Results after endoscopic treatment of postoperative upper gastrointestinal fistulas and leaks using combined Vicryl plug and fibrin glue. Surg Endosc 18(7):1105–1108

    Article  CAS  PubMed  Google Scholar 

  11. Bohm G, Mossdorf A, Klink C, Klinge U, Jansen M, Schumpelick V, Truong S (2010) Treatment algorithm for postoperative upper gastrointestinal fistulas and leaks using combined vicryl plug and fibrin glue. Endoscopy 42(7):599–602

    Article  CAS  PubMed  Google Scholar 

  12. Pross M, Manger T, Reinheckel T, Mirow L, Kunz D, Lippert H (2000) Endoscopic treatment of clinically symptomatic leaks of thoracic esophageal anastomoses. Gastrointest Endosc 51(1):73–76

    Article  CAS  PubMed  Google Scholar 

  13. Tasdemir O, Kucukaksu DS, Karagoz H, Bayazit K (1996) Beneficial effects of fibrin glue on esophageal perforation. Ann Thorac Surg 61(5):1589

    Article  CAS  PubMed  Google Scholar 

  14. Cipolletta L, Bianco MA, Rotondano G, Marmo R, Piscopo R, Meucci C (2000) Endoscopic clipping of perforation following pneumatic dilation of esophagojejunal anastomotic strictures. Endoscopy 32(9):720–722

    Article  CAS  PubMed  Google Scholar 

  15. Kim YJ, Shin SK, Lee HJ, Chung HS, Lee YC, Park JC, Hyung WJ, Noh SH, Kim CB, Lee SK (2013) Endoscopic management of anastomotic leakage after gastrectomy for gastric cancer: how efficacious is it? Scand J Gastroenterol 48(1):111–118

    Article  PubMed  Google Scholar 

  16. Doniec JM, Schniewind B, Kahlke V, Kremer B, Grimm H (2003) Therapy of anastomotic leaks by means of covered self-expanding metallic stents after esophagogastrectomy. Endoscopy 35(8):652–658

    Article  CAS  PubMed  Google Scholar 

  17. Amrani L, Menard C, Berdah S, Emungania O, Soune PA, Subtil C, Brunet C, Grimaud JC, Barthet M (2009) From iatrogenic digestive perforation to complete anastomotic disunion: endoscopic stenting as a new concept of “stent-guided regeneration and re-epithelialization. Gastrointest Endosc 69(7):1282–1287

    Article  PubMed  Google Scholar 

  18. Salminen P, Gullichsen R, Laine S (2009) Use of self-expandable metal stents for the treatment of esophageal perforations and anastomotic leaks. Surg Endosc 23(7):1526–1530

    Article  CAS  PubMed  Google Scholar 

  19. Siersema PD (2009) Stenting for benign esophageal strictures. Endoscopy 41(4):363–373

    Article  CAS  PubMed  Google Scholar 

  20. Roy-Choudhury SH, Nicholson AA, Wedgwood KR, Mannion RA, Sedman PC, Royston CM, Breen DJ (2001) Symptomatic malignant gastroesophageal anastomotic leak: management with covered metallic esophageal stents. AJR Am J Roentgenol 176(1):161–165

    Article  CAS  PubMed  Google Scholar 

  21. Han XW, Li YD, Wu G, Li MH, Ma XX (2006) New covered mushroom-shaped metallic stent for managing anastomotic leak after esophagogastrostomy with a wide gastric tube. Ann Thorac Surg 82(2):702–706

    Article  PubMed  Google Scholar 

  22. Edge SBBD, Compton CC, Fritz AG, Greene FL, Trotti A (2009) AJCC cancer staging manual, 7th edn. Springer, New York

    Google Scholar 

  23. Schweigert M, Dubecz A, Stadlhuber RJ, Muschweck H, Stein HJ (2011) Treatment of intrathoracic esophageal anastomotic leaks by means of endoscopic stent implantation. Interact Cardiovasc Thorac Surg 12(2):147–151

    Article  PubMed  Google Scholar 

  24. Vanbiervliet G, Filippi J, Karimdjee BS, Venissac N, Iannelli A, Rahili A, Benizri E, Pop D, Staccini P, Tran A, Schneider S, Mouroux J, Gugenheim J, Benchimol D, Hebuterne X (2012) The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study. Surg Endosc 26(1):53–59

    Article  PubMed  Google Scholar 

  25. van Boeckel PG, Sijbring A, Vleggaar FP, Siersema PD (2011) Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther 33(12):1292–1301

    Article  PubMed  Google Scholar 

  26. Swinnen J, Eisendrath P, Rigaux J, Kahegeshe L, Lemmers A, Le Moine O, Deviere J (2011) Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc 73(5):890–899

    Article  PubMed  Google Scholar 

  27. Attar S, Hankins JR, Suter CM, Coughlin TR, Sequeira A, McLaughlin JS (1990) Esophageal perforation: a therapeutic challenge. Ann Thorac Surg 50(1):45–49

    Article  CAS  PubMed  Google Scholar 

  28. Sung SW, Park JJ, Kim YT, Kim JH (2002) Surgery in thoracic esophageal perforation: primary repair is feasible. Dis Esophagus 15(3):204–209

    Article  CAS  PubMed  Google Scholar 

  29. Wright CD, Mathisen DJ, Wain JC, Moncure AC, Hilgenberg AD, Grillo HC (1995) Reinforced primary repair of thoracic esophageal perforation. Ann Thorac Surg 60(2):245–248

    Article  CAS  PubMed  Google Scholar 

  30. Fischer A, Thomusch O, Benz S, von Dobschuetz E, Baier P, Hopt UT (2006) Nonoperative treatment of 15 benign esophageal perforations with self-expandable covered metal stents. Ann Thorac Surg 81(2):467–472

    Article  PubMed  Google Scholar 

  31. Adamek HE, Jakobs R, Dorlars D, Martin WR, Kromer MU, Riemann JF (1997) Management of esophageal perforations after therapeutic upper gastrointestinal endoscopy. Scand J Gastroenterol 32(5):411–414

    Article  CAS  PubMed  Google Scholar 

  32. Schubert D, Scheidbach H, Kuhn R, Wex C, Weiss G, Eder F, Lippert H, Pross M (2005) Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc 61(7):891–896

    Article  PubMed  Google Scholar 

  33. Evrard S, Le Moine O, Lazaraki G, Dormann A, El Nakadi I, Deviere J (2004) Self-expanding plastic stents for benign esophageal lesions. Gastrointest Endosc 60(6):894–900

    Article  PubMed  Google Scholar 

  34. van Heel NC, Haringsma J, Spaander MC, Bruno MJ, Kuipers EJ (2010) Short-term esophageal stenting in the management of benign perforations. Am J Gastroenterol 105(7):1515–1520

    Article  PubMed  Google Scholar 

  35. Mayoral W, Fleischer D, Salcedo J, Roy P, Al-Kawas F, Benjamin S (2000) Nonmalignant obstruction is a common problem with metal stents in the treatment of esophageal cancer. Gastrointest Endosc 51(5):556–559

    Article  CAS  PubMed  Google Scholar 

  36. Hirdes MM, Vleggaar FP, Van der Linde K, Willems M, Totte ER, Siersema PD (2011) Esophageal perforation due to removal of partially covered self-expanding metal stents placed for a benign perforation or leak. Endoscopy 43(2):156–159

    Article  CAS  PubMed  Google Scholar 

  37. van Boeckel PG, Dua KS, Weusten BL, Schmits RJ, Surapaneni N, Timmer R, Vleggaar FP, Siersema PD (2012) Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks. BMC Gastroenterol 12:19

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Disclosures

Choong Nam Shim, Hyoung-Il Kim, Woo Jin Hyung, Sung Hoon Noh, Mi Kyung Song, Dae Ryong Kang, Jun Chul Park, Hyuk Lee, Sung Kwan Shin, Yong Chan Lee, and Sang Kil Lee have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul, 120-752, South Korea

    Choong Nam Shim, Jun Chul Park, Hyuk Lee, Sung Kwan Shin, Yong Chan Lee & Sang Kil Lee

  2. Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, South Korea

    Hyoung-Il Kim, Woo Jin Hyung & Sung Hoon Noh

  3. Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea

    Mi Kyung Song & Dae Ryong Kang

Authors
  1. Choong Nam Shim
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Hyoung-Il Kim
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Woo Jin Hyung
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Sung Hoon Noh
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Mi Kyung Song
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Dae Ryong Kang
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Jun Chul Park
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Hyuk Lee
    View author publications

    You can also search for this author inPubMed Google Scholar

  9. Sung Kwan Shin
    View author publications

    You can also search for this author inPubMed Google Scholar

  10. Yong Chan Lee
    View author publications

    You can also search for this author inPubMed Google Scholar

  11. Sang Kil Lee
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Sang Kil Lee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shim, C.N., Kim, HI., Hyung, W.J. et al. Self-expanding metal stents or nonstent endoscopic therapy: which is better for anastomotic leaks after total gastrectomy?. Surg Endosc 28, 833–840 (2014). https://doi.org/10.1007/s00464-013-3228-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-013-3228-5

Keywords

Profiles

  1. Woo Jin Hyung View author profile
  2. Sang Kil Lee View author profile