Abstract
Simple SummaryA covered self-expandable metal stent using external fixation using silk thread (thread-fix stent) is an effective treatment for anastomotic leakage after esophago-gastric surgery. However, a thread-fix stent also entails long hospitalization and patient discomfort. This study found that the Niti-S Beta stent which does not need thread-fix was an effective treatment for anastomotic leakage after total or proximal gastrectomy for gastric cancer. Because patients who received the Nitis-S Beta stent had minimal discomfort, the stent maintenance was possible without hospitalization.A thread-fix stent entails long hospitalization and patient discomfort. We aimed to evaluate the efficacy of a novel stent with silicone-covered outer double layers without external fixation (Beta stent) for anastomotic leakage after total or proximal gastrectomy. The outcomes were compared between gastric cancer patients who underwent stent placement using a thread-fix stent between 2014 and 2015 (Thread-Fix Group) and those who received a Beta stent in the succeeding period until October 2018 (Beta Stent Group). The Beta Stent Group (n = 14) had a significantly higher leakage healing rate by the first stent placement (92.9% vs. 53.8%; p = 0.021) and had a shorter hospitalization period (median: 16 days vs. 28 days; p = 0.037) than the Thread-Fix Group (n = 13). Further, 50% of the Beta stent patients received outpatient management until stent removal. Stent maintenance duration was significantly longer in the Beta Stent Group (median, 28 days vs. 18 days; p = 0.006). There was no significant between-group difference in stent-related complications except for stent migration (7.1% (Beta Stent Group) vs. 0% (Thread-Fix Group), p = 0.326). In conclusion, the Niti-S Beta stent is an effective treatment for anastomotic leakage from total or proximal gastrectomy for gastric cancer. Stent maintenance is possible without hospitalization.
Highlights
Anastomotic leakage is one of the most serious and potentially fatal complications after gastrectomy, impairing quality of life, prolonging hospitalization, and increasing mortality [1,2,3]
Depending on the reconstruction method, anastomotic leakage occurs in 0–17% of patients after total gastrectomy [4] and in 0–5% after proximal gastrectomy [5,6,7]
The present study aimed to investigate the efficacy of the Niti-S Beta stent for the treatment of anastomotic leakage from total or proximal gastrectomy for gastric cancer
Summary
Anastomotic leakage is one of the most serious and potentially fatal complications after gastrectomy, impairing quality of life, prolonging hospitalization, and increasing mortality [1,2,3]. The therapeutic options for anastomotic leakage after total or proximal gastrectomy include conservative, endoscopic, and surgical treatments. Stent migration can occur in up to 61% of patients who underwent esophagojejunostomy [12], and external fixation through the nose of SEMS using a silk thread (thread-fix stent) was developed. This successfully eliminated the risk of stent migration [14,15]. The thread-fix stent is associated with prolonged discomfort and longer hospitalization than the SEMS without external fixation due to the external fixation state during leakage healing
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