Ali Kemal KAYAPINAR, Erkan OYMACI, Süleyman GÜNAY, Durmuş Ali ÇETİN, Bülent ÇALIK, Kemal Erdinc KAMER, Mehmet YILDIRIM

Comparison of self-expanding metal stent results in esophagogastrostomy and esophagojejunostomy anastomotic leak: a three-center retrospective analysis

Aim: Our aim was to compare the efficacy and complications of self-expanding metal stents (SEMS) in anastomotic leaks related to esophagogastrostomy (EG) and esophago jejunostomy (EJ). Materials and Methods: Demographic characteristics, types of surgery, anastomotic leak detection time, clinical findings, diagnostic methods, radiological and endoscopic find ings, biochemical findings, efficacy and complications of SEMS, morbidity, and mortality rates of 17 patients who underwent SEMS due to EG (8 cases) or EJ (9 cases) anasto motic leakage after esophageal and gastric tumor resection between 2013 and 2019 were compared. Mann-Whitney U test was used in the analysis of quantitative variables, Fisher Exact and Fisher-Freeman-Holton tests were used in the analysis of categorical variables. Results: While early term SEMS migration was not observed in the EG group, it was observed in 5 (55.5%) cases in the EJ group (p=0.564). In the EJ group, laceration in the jejunal loop due to SEMS migration was observed in 1 (11.1%) case, and intestinal perforation was observed in 1 (11.1%) case. The amount of anastomotic leakage after SEMS was significantly decreased in the EG group compared to the EJ group (p=0.028). C-reactive protein values were lower and albumin levels were higher in the EG group compared to EJ group (p=0.093, p=0.078, respectively). Mortality was seen in 1 (12.5%) patient in the EG group and in 5 (55.5%) patients in the EJ group (p=0.131). The mean age of those who developed mortality was higher than those who did not (p=0.015). Conclusion: While SEMS is effective in EG anastomotic leakage, its success rate is low in EJ anastomotic leakage.

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1. Blencowe NS, Strong S, McNair AG, et al. Reporting of short term clinical outcomes after esophagectomy: a systematic re view. Annals of surgery. 2012; 255(4) : 658-666.
2. Lang H, Piso P, Stukenborg C, Raab R, Jähne J. Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. European journal of surgical oncology. 2000; 26(2): 168-171.
3. Cereatti F, Grassia R, Drago, A, Conti CB, Donatelli G. Endo scopic management of gastrointestinal leaks and fistulae: What option do we have? World Journal of Gastroenterology. 2020; 26(29): 4198–4217.
4. Siddiqi S, Schraufnagel DP, Siddiqui HU, et al. Recent advance ments in the minimally invasive management of esophageal per foration, leaks, and fistulae. Expert review of medical devices. 2019; 16(3):197-209.
5. Makuuchi R, Irino T, Tanizawa Y, et al. Esophagojejunal anas tomotic leakage following gastrectomy for gastric cancer. Surgery today. 2019; 49(3): 187-196.
6. Hoeppner J, Kulemann B, Seifert G, et al. Covered self expanding stent treatment for anastomotic leakage: outcomes in esophagogastric and esophagojejunal anastomoses. Surgical endoscopy. 2014; 28(5): 1703-1711.
7. Persson S, Rouvelas I, Kumagai K, et al. Treatment of esophageal anastomotic leakage with self-expanding metal stents: analysis of risk factors for treatment failure. Endoscopy international open. 2016; 4(04): E420-E426.
8. Verstegen MH, Bouwense SA, van Workum F, et al. Man agement of intrathoracic and cervical anastomotic leakage af ter esophagectomy for esophageal cancer: a systematic review. World Journal of Emergency Surgery. 2019; 14(1): 1-12.
9. Shim CS, Cho YD, Moon JH, et al. Fixation of a modified cov ered esophageal stent: its clinical usefulness for preventing stent migration. Endoscopy. 2001; 33(10): 843-848.
10. Swinnen J, Eisendrath P, Rigaux J, et al. Self-expandable metal stents for the treatment of benign upper GI leaks and perfora tions. Gastrointestinal endoscopy. 2011; 73(5): 890-899.
11. Bohle W, Louris I, Schaudt A, et al. Predictors for Treatment Failure of Self-Expandable Metal Stents for Anastomotic Leak after Gastro-Esophageal Resection. Journal of Gastrointestinal & Liver Diseases. 2020; 29(2): 145-149.
12. Swinnen J, Eisendrath P, Rigaux J, et al. Self-expandable metal stents for the treatment of benign upper GI leaks and perfora tions. Gastrointestinal endoscopy. 2011; 73(5): 890-899.
13. Feith M, Gillen S, Schuster T, et al. Healing occurs in most patients that receive endoscopic stents for anastomotic leakage; dislocation remains a problem. Clinical Gastroenterology and Hepatology. 2011; 9(3): 202-210.
14. Fischer A, Bausch D, Richter-Schrag HJ. Use of a specially de signed partially covered self-expandable metal stent (PSEMS) with a 40-mm diameter for the treatment of upper gastrointesti nal suture or staple line leaks in 11 cases. Surgical endoscopy. 2013; 27(2): 642-647.
15. Speer E, Dunst CM, Shada A, et al. Covered stents in cervical anastomoses following esophagectomy. Surgical endoscopy. 2016; 30(8): 3297-3303.
16. Licht E, Markowitz AJ, Bains MS, et al. Endoscopic manage ment of esophageal anastomotic leaks after surgery for malignant disease. The Annals of thoracic surgery. 2016; 101(1): 301-304.
17. Schaheen L, Blackmon SH, Nason KS. Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review. The American Journal of Surgery. 2014; 208(4): 536-543.
18. Choi CW, Kang DH, Kim HW, et al. Full covered self expandable metal stents for the treatment of anastomotic leak using a silk thread. Medicine. 2017; 96(29): e7439.
19. Irani S, Baron TH, Gluck M, et al. Preventing migration of fully covered esophageal stents with an over-the-scope clip device (with videos). Gastrointestinal endoscopy. 2014; 79(5): 844-851.
20. John A, Chowdhury SD, Kurien RT, et al. Self-expanding metal stent in esophageal perforations and anastomotic leaks. Indian Journal of Gastroenterology. 2020; 39(5): 445-449.
21. Law R, Prabhu A, Fujii-Lau L, et al. Stent migration following endoscopic suture fixation of esophageal self-expandable metal stents: a systematic review and meta-analysis. Surgical en doscopy. 2018; 32(2): 675- 681.
22. Raimondo D, Sinagra E, Facella T, et al. Self-expandable metal stent placement for closure of a leak after total gastrectomy for gastric cancer: report on three cases and review of the literature. Case reports in gastrointestinal medicine. 2014; 2014:1-5.
23. Aday U, Gündeş E, Çiyiltepe H, et al. Examination of anas tomotic leak with aqueous contrast swallow after total gastrec tomy: Should it be carried out routinely?. Contemporary oncol ogy. 2017; 21(3): 224–227.
24. Migita K, Takayama T, Matsumoto S, et al. Risk factors for esophagojejunal anastomotic leakage after elective gastrectomy for gastric cancer. Journal of Gastrointestinal Surgery. 2012; 16(9): 1659-1665.
25. Tu RH, Lin JX, Zheng CH, et al. Development of a nomogram for predicting the risk of anastomotic leakage after a gastrectomy for gastric cancer. European Journal of Surgical Oncology (EJSO). 2017; 43(2): 485-492.
26. Yu Y, T Liu J, Hu B, et al. Expert consensus on the use of human serum albumin in critically ill patients. Chinese Medical Journal. 2021; 134(14): 1639–1654.
27. Isik A, Firat D, Peker K, et al. A case report of esophageal perforation: Complication of nasogastric tube placement. The American journal of case reports. 2014; 15: 168.