Self-expanding plastic stent for esophageal leaks and fistulae.

Abstract

Self-expanding plastic stents (SEPS) have emerged as a good alternative to surgery in esophageal leaks and fistulae. There is scarce published literature regarding its efficacy in these conditions. We present our experience with SEPS in treatment of esophageal leaks and fistulae. Consecutive patients admitted in a tertiary referral center who underwent SEPS placement for esophageal leak or fistula between February 2012 and February 2015 were retrospectively evaluated. Patients underwent prior assessment with upper gastrointestinal endoscopic and thoracic contrast-enhanced computed tomography assessment. SEPS (25-mm flares, 21-mm diameter) were placed under fluoroscopic guidance. A silk thread tied to upper end was routed through nostril and fixed to prevent stent migration. Nasojejunal tube was inserted in all patients. Intercostal drain was inserted in the case of hydro/pyopneumothorax. Twelve patients [eight male, median age 45.3years (19 to 65years)] were included. Etiologies were spontaneous leaks due to Boerhaave syndrome (n=2), corrosive fistulae (n=2), tubercular fistulae (n=4), invasive Candida esophagitis-induced fistula (n=1), iatrogenic leaks (n=2; one achalasia dilatation, one obesity surgery), and pancreaticoesophageal fistula due to ruptured pancreatic pseudocyst (n=1). Stent placement was successful in all patients with no immediate postprocedure complications. Successful healing was seen in nine patients (75%). Stents were removed after a median time of 83.5days (13-190days). Stent migration was seen in four patients (33.3%), and in two of them, it was retrieved and redeployed; none had early migration (<72h). Reasons for SEPS failure in our cohort were failure of effective sepsis control in two patients and poor wound healing seen in one patient having multiple tubercular fistulae. SEPS is a safe, well-tolerated treatment with good success rate (75%) in treatment of esophageal leaks and fistulae.