28 323

Cited 0 times in

Proximal-releasing stent insertion under transnasal endoscopic guidance in patients with postoperative esophageal leakage.

Authors
Lee, KM; Shin, SJ; Hwang, JC; Yoo, BM; Cheong, JY; Lim, SG; Kim, JK; Cho, YK; Han, SU; Lee, SR; Kim, JH
Citation
Gastrointestinal endoscopy, 72(1):180-185, 2010
Journal Title
Gastrointestinal endoscopy
ISSN
0016-51071097-6779
Abstract
BACKGROUND: Covered metallic or plastic stent placement has become an important treatment for postoperative esophageal leakage; however, fluoroscopic guidance is also required. Here we present a novel stent insertion technique with a newly designed proximal-releasing, self-expanding metallic stent (PR-SEMS) and transnasal endoscope that can enable stent insertion without fluoroscopy as a new method to prevent stent migration.

OBJECTIVE: To describe our experience with 7 patients who underwent PR-SEMS insertion with the direct-vision technique and our use of the transnasal endoscope without fluoroscopy.

DESIGN: Prospective outcome study.

SETTING: A tertiary-care referral university hospital.

PATIENTS: This study involved all patients at our center who experienced postoperative esophageal leakage after esophagectomy, primary closure, or total gastrectomy.

INTERVENTION: PR-SEMS insertion with the direct vision technique and use of transnasal endoscopy without fluoroscopy.

MAIN OUTCOME MEASUREMENTS: Success rate of stent insertion, healing rate of postoperative esophageal leaks, and stent migration rate.

RESULTS: All stents were placed at the expected location without complications. One patient had massive hematemesis and underwent surgery. The bleeding focus was the splenic artery, which was damaged during gastrectomy. A significant marginal ulcer occurred in one patient, and the stent was immediately retrieved with an endoscope. After stent removal, 4 postoperative leakages were completely healed, and 2 lesions were not occluded. The 2 remaining minimal lesions became completely occluded with conservative management after stent removal. Stent migration did not occur.

LIMITATIONS: A small number of patients. Further prospective, randomized, controlled trials are needed.

CONCLUSION: PR-SEMS insertion under transnasal endoscopic guidance is a feasible, safe, and effective treatment for postoperative esophageal leakage, and it can be performed as a bedside procedure. Our anchoring method is effective for the prevention of migration from nonobstructed lesions.
MeSH terms
AgedDevice RemovalEsophageal Neoplasms/*surgery*Esophagectomy*Esophagoscopes*EsophagostomyFemaleFluoroscopyFollow-Up Studies*GastrectomyHematemesis/etiologyHumans*JejunostomyMaleMiddle AgedPostoperative Complications/*therapyProspective StudiesSplenic Artery/injuries*StentsStomach Neoplasms/*surgerySurgical Wound Dehiscence/*therapyUlcer/etiology
DOI
10.1016/j.gie.2010.02.052
PMID
20546733
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Gastroenterology
Journal Papers > School of Medicine / Graduate School of Medicine > Radiology
Journal Papers > School of Medicine / Graduate School of Medicine > Surgery
AJOU Authors
이, 기명신, 성재황, 재철유, 병무정, 재연임, 선교김, 재근조, 용관한, 상욱김, 진홍
Full Text Link
Export
RIS (EndNote)
XLS (Excel)
XML

qrcode

해당 아이템을 이메일로 공유하기 원하시면 인증을 거치시기 바랍니다.

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Browse