Self-expandable metallic stent application for the management of upper gastrointestinal tract disease
Arif Emre1, Mehmet Sertkaya1, Sami Akbulut2, Ozan Erbil3, Nursel Yurttutan4, İlhami Taner Kale1, Ertan Bülbüloğlu1
1Department of General Surgery, Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
2Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey
3Department of General Surgery, Gebze State Hospital, İzmit, Turkey
4Department of Radiology, Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
Keywords: Leakage, metallic stents, stenosis, upper gastrointestinal tract
Objective: The aim of the present study was to share our experiences of the use of self-expandable metallic stent for the upper gastrointestinal tract disease.
Material and Methods: We retrospectively reviewed the medical records of 18 patients who underwent self-expandable metallic stent implantation procedure for anastomosis stricture, anastomosis leak, or spontaneous fistula of the upper gastrointestinal tract at two different surgery clinics. Self-expandable metallic stent implantation procedures were performed while keeping the patient under sedation and the correct stent localization was verified using fluoroscopy. The stent localization and possible stent migration were checked using X-ray films taken a few days after the stenting procedure.
Results: Overall, 25 self-expandable metallic stents were implanted in 18 patients (malignant, 13; benign, 5) aged between 19 and 89 years. The indications for self-expandable metallic stent implantation were as follows: malignant gastric stricture (inoperable; n=6), malignant esophageal stricture (inoperable; n=4), staple line leak (laparoscopic sleeve gastrectomy; n=4), esophagojejunostomy anastomotic leak (total gastrectomy+Roux-en-Yesophagojejunostomy; n=2), and stricture (total gastrectomy+Roux-en-Yesophagojejunostomy; n=1), and esophagopleural fistula (pulmonary tuberculosis; n=1). A favorable outcome was achieved in a single session in 15 patients, whereas more than two sessions of stenting were necessary in the remaining three patients. Among the patients who underwent esophagojejunal anastomosis (n=3), self-expandable metallic stents were successfully deployed in a single session in two patients to relieve anastomosis leak (n=1) and anastomosis stricture (n=1); the remaining patients underwent four self-expandable metallic stent implantation procedures to relieve anastomosis leak and subsequent recurrent strictures. No complications developed during the stenting procedure. Three of the four patients who developed mortality had advanced stage esophageal cancer, whereas one patient had morbid obesity and developed staple line leakage.
Conclusion: Endoscopic self-expandable metallic stent implantation under fluoroscopic guidance is a low-morbidity and effective procedure for the management of advanced stage tumors of the gastrointestinal tract and the elimination of postoperative complications.
Cite this paper as: Emre A, Sertkaya M, Akbulut S, Erbil O, Yurttutan N, Kale İT, et al. Self-expandable metallic stents for upper gastrointestinal tract disease: Clinical experiences. Turk J Surg 2018; 34: 101-105.
This study was presented at the “33. National Gastroenterology Week, “22-27 November 2016”, “Antalya, Turkey”.
Ethics committee approval was received for this study from the ethics committee of Kahramanmaraş Sütçü İmam University School of Medicine.
Written informed consent was obtained from patient who participated in this study.
Concept - A.E., M.S., S.A.; Design - A.E., O.E., N.Y.; Supervision - İ.T.K., E.B., A.E.; Resource - A.E.; Materials - A.E., O.E., N.Y.; Data Collection and/or Processing - A.E., O.E., N.Y.; Analysis and/or Interpretation - A.E., S.A.; Literature Search - A.E., S.A., N.Y.; Writing Manuscript -A.E.; Critical Reviews - İ.T.K., A.E., S.A.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.