Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus
Open Access
- 24 April 2011
- journal article
- review article
- Published by Wiley in Alimentary Pharmacology & Therapeutics
- Vol. 33 (12), 1292-1301
- https://doi.org/10.1111/j.1365-2036.2011.04663.x
Abstract
Placement of self-expanding metal stents (SEMS) or plastic stents (SEPS) has emerged as a minimally invasive treatment option for benign oesophageal ruptures and leaks; however, it is not clear which stent type should be preferred. To assess clinical effectiveness and safety of treating benign oesophageal ruptures and anastomotic leaks with temporary placement of a stent with special emphasis on different stent designs. A pooled analysis was performed after searching PubMed and EMBASE databases for studies regarding placement of fully covered and partially covered SEMS (FSEMS and PSEMS) and SEPS for this indication. Data were pooled and evaluated for clinical outcome, complications and survival. Twenty-five studies, including 267 patients with complete follow-up on outcome, were identified. Clinical success was achieved in 85% of patients and was not different between stent types (SEPS 84%, FSEMS 85% and PSEMS 86%, P = 0.97). Time of stent placement was longest for SEPS (8 weeks) followed by FSEMS and PSEMS (both 6 weeks). In total, 65 (34%) patients had a stent-related complication. Stent migration occurred more often with SEPS [n = 47 (31%)] and FSEMS [n = 7 (26%)] than with PSEMS [n = 2 (12%), P ≤ 0.001], whereas there was no significant difference in tissue in- and overgrowth between PSEMS [12% vs. 7% (FSEMS) and 3% (SEPS), P = 0.68]. Although there is a lack of randomised controlled trials, it seems that covered stent placement for a period of 6-8 weeks is safe and effective for benign oesophageal ruptures and anastomotic leaks to heal. As efficacy between different stent types is not significantly different, stent choice should depend on expected risk of stent migration (self-expanding plastic stents and fully covered self-expanding metal stents) and, to a minor degree, on expected risk of tissue in- or overgrowth (partially covered self-expanding metal stents).Keywords
This publication has 48 references indexed in Scilit:
- From iatrogenic digestive perforation to complete anastomotic disunion: endoscopic stenting as a new concept of “stent-guided regeneration and re-epithelialization”Gastrointestinal Endoscopy, 2009
- Postoperative esophageal leak management with the Polyflex esophageal stentThe Journal of Thoracic and Cardiovascular Surgery, 2007
- Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trialThe Lancet, 2004
- La mortalité des perforations instrumentales de l’œsophage est élevée : expérience de 54 cas traitésAnnales de Chirurgie, 2002
- Management of Esophageal PerforationSurgery Today, 2001
- Reinforced primary repair of thoracic esophageal perforationThe Annals of Thoracic Surgery, 1995
- Intrathoracic esophageal perforation: The merit of primary repairThe Journal of Thoracic and Cardiovascular Surgery, 1995
- Esophageal perforation: A therapeutic challengeThe Annals of Thoracic Surgery, 1990
- Experience with the Grillo Pleural Wrap Procedure in 18 Patients with Perforation of the Thoracic EsophagusAnnals of Surgery, 1989
- Treatment of instrumental oesophageal perforation.Gut, 1984