Treatment of esophageal leaks, fistulae, and perforations with temporary stents: Evaluation of efficacy, adverse events, and factors associated with successful outcomes

Ihab I. El Hajj, Thomas Imperiale, Douglas Rex, Darren Ballard, Kenneth Kesler, Thomas Birdas, Hala Fatima, William Kessler, John DeWitt

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Abstract

Background Factors associated with successful endoscopic therapy with temporary stents for esophageal leaks, fistulae, and perforations (L/F/P) are not well known. Objectives To evaluate the safety, efficacy, and outcomes of esophageal stenting in these patients and identify factors associated with successful closure. Design Retrospective. Setting Academic tertiary referral center. Patients All patients with attempted stent placement for esophageal L/F/P between January 2003 and May 2012. Intervention Esophageal stent placement and removal. Main Outcome Measurements Factors predictive of therapeutic success defined as complete closure after index stent removal (primary closure) or after further endoscopic stenting (secondary closure). Results Sixty-seven patients with 132 attempted stents for esophageal L/F/P were considered; 13 patients were excluded. Among the remaining 54 patients, 117 stents were placed for leaks (29 patients; 64 stents), fistulae (15 patients; 36 stents), and perforations (10 patients; 17 stents). Procedural technical success was achieved in all patients (100%). Primary closure was successful in 40 patients (74%) and secondary closure in an additional 5 (83% overall). On short-term (<3 months) follow-up, 27 patients (50%) were asymptomatic, whereas 22 (41%) had technical adverse events, including stent migration in 15 patients (28%). Factors associated with successful primary closure include a shorter time between diagnosis of esophageal L/F/P and initial stent insertion (9.03 vs 22.54 days; P =.003), and a smaller luminal opening size (P =.002). Limitations Retrospective, single-center study. Conclusions Temporary stents are safe and effective in treating esophageal L/F/P. Defect opening size and time from diagnosis to stent placement appear to be candidate predictors for successful closure.

Original languageEnglish
Pages (from-to)589-598
Number of pages10
JournalGastrointestinal Endoscopy
Volume79
Issue number4
DOIs
StatePublished - 2014

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Esophageal Fistula
Esophageal Perforation
Stents
Therapeutics
Tertiary Care Centers
Fistula

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

@article{e8ee7e32937c4d81a1c437e0e26cba9f,
title = "Treatment of esophageal leaks, fistulae, and perforations with temporary stents: Evaluation of efficacy, adverse events, and factors associated with successful outcomes",
abstract = "Background Factors associated with successful endoscopic therapy with temporary stents for esophageal leaks, fistulae, and perforations (L/F/P) are not well known. Objectives To evaluate the safety, efficacy, and outcomes of esophageal stenting in these patients and identify factors associated with successful closure. Design Retrospective. Setting Academic tertiary referral center. Patients All patients with attempted stent placement for esophageal L/F/P between January 2003 and May 2012. Intervention Esophageal stent placement and removal. Main Outcome Measurements Factors predictive of therapeutic success defined as complete closure after index stent removal (primary closure) or after further endoscopic stenting (secondary closure). Results Sixty-seven patients with 132 attempted stents for esophageal L/F/P were considered; 13 patients were excluded. Among the remaining 54 patients, 117 stents were placed for leaks (29 patients; 64 stents), fistulae (15 patients; 36 stents), and perforations (10 patients; 17 stents). Procedural technical success was achieved in all patients (100{\%}). Primary closure was successful in 40 patients (74{\%}) and secondary closure in an additional 5 (83{\%} overall). On short-term (<3 months) follow-up, 27 patients (50{\%}) were asymptomatic, whereas 22 (41{\%}) had technical adverse events, including stent migration in 15 patients (28{\%}). Factors associated with successful primary closure include a shorter time between diagnosis of esophageal L/F/P and initial stent insertion (9.03 vs 22.54 days; P =.003), and a smaller luminal opening size (P =.002). Limitations Retrospective, single-center study. Conclusions Temporary stents are safe and effective in treating esophageal L/F/P. Defect opening size and time from diagnosis to stent placement appear to be candidate predictors for successful closure.",
author = "{El Hajj}, {Ihab I.} and Thomas Imperiale and Douglas Rex and Darren Ballard and Kenneth Kesler and Thomas Birdas and Hala Fatima and William Kessler and John DeWitt",
year = "2014",
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TY - JOUR

T1 - Treatment of esophageal leaks, fistulae, and perforations with temporary stents

T2 - Evaluation of efficacy, adverse events, and factors associated with successful outcomes

AU - El Hajj, Ihab I.

AU - Imperiale, Thomas

AU - Rex, Douglas

AU - Ballard, Darren

AU - Kesler, Kenneth

AU - Birdas, Thomas

AU - Fatima, Hala

AU - Kessler, William

AU - DeWitt, John

PY - 2014

Y1 - 2014

N2 - Background Factors associated with successful endoscopic therapy with temporary stents for esophageal leaks, fistulae, and perforations (L/F/P) are not well known. Objectives To evaluate the safety, efficacy, and outcomes of esophageal stenting in these patients and identify factors associated with successful closure. Design Retrospective. Setting Academic tertiary referral center. Patients All patients with attempted stent placement for esophageal L/F/P between January 2003 and May 2012. Intervention Esophageal stent placement and removal. Main Outcome Measurements Factors predictive of therapeutic success defined as complete closure after index stent removal (primary closure) or after further endoscopic stenting (secondary closure). Results Sixty-seven patients with 132 attempted stents for esophageal L/F/P were considered; 13 patients were excluded. Among the remaining 54 patients, 117 stents were placed for leaks (29 patients; 64 stents), fistulae (15 patients; 36 stents), and perforations (10 patients; 17 stents). Procedural technical success was achieved in all patients (100%). Primary closure was successful in 40 patients (74%) and secondary closure in an additional 5 (83% overall). On short-term (<3 months) follow-up, 27 patients (50%) were asymptomatic, whereas 22 (41%) had technical adverse events, including stent migration in 15 patients (28%). Factors associated with successful primary closure include a shorter time between diagnosis of esophageal L/F/P and initial stent insertion (9.03 vs 22.54 days; P =.003), and a smaller luminal opening size (P =.002). Limitations Retrospective, single-center study. Conclusions Temporary stents are safe and effective in treating esophageal L/F/P. Defect opening size and time from diagnosis to stent placement appear to be candidate predictors for successful closure.

AB - Background Factors associated with successful endoscopic therapy with temporary stents for esophageal leaks, fistulae, and perforations (L/F/P) are not well known. Objectives To evaluate the safety, efficacy, and outcomes of esophageal stenting in these patients and identify factors associated with successful closure. Design Retrospective. Setting Academic tertiary referral center. Patients All patients with attempted stent placement for esophageal L/F/P between January 2003 and May 2012. Intervention Esophageal stent placement and removal. Main Outcome Measurements Factors predictive of therapeutic success defined as complete closure after index stent removal (primary closure) or after further endoscopic stenting (secondary closure). Results Sixty-seven patients with 132 attempted stents for esophageal L/F/P were considered; 13 patients were excluded. Among the remaining 54 patients, 117 stents were placed for leaks (29 patients; 64 stents), fistulae (15 patients; 36 stents), and perforations (10 patients; 17 stents). Procedural technical success was achieved in all patients (100%). Primary closure was successful in 40 patients (74%) and secondary closure in an additional 5 (83% overall). On short-term (<3 months) follow-up, 27 patients (50%) were asymptomatic, whereas 22 (41%) had technical adverse events, including stent migration in 15 patients (28%). Factors associated with successful primary closure include a shorter time between diagnosis of esophageal L/F/P and initial stent insertion (9.03 vs 22.54 days; P =.003), and a smaller luminal opening size (P =.002). Limitations Retrospective, single-center study. Conclusions Temporary stents are safe and effective in treating esophageal L/F/P. Defect opening size and time from diagnosis to stent placement appear to be candidate predictors for successful closure.

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U2 - 10.1016/j.gie.2013.08.039

DO - 10.1016/j.gie.2013.08.039

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JF - Gastrointestinal Endoscopy

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