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Self-expandable metal stent placement for closure of a leak after total gastrectomy for gastric cancer: report on three cases and review of the literature.

Raimondo D, Sinagra E, Facella T, Rossi F, Messina M, Spada M, Martorana G, Marchesa PE, Squatrito R, Tomasello G, Lo Monte AI, Pompei G, La Rocca E - Case Rep Gastrointest Med (2014)

Bottom Line: In the setting of the curative oncological surgery, the gastric surgery is exposed to complicated upper gastrointestinal leaks, and consequently the management of this problem has become more critically focused than was previously possible.The promising results of our report, despite the small number of patients, suggest that early stenting (through a partially silicone-coated SEMS) is a feasible alternative to surgical treatment in this subset of patients.However, prospective studies with a larger number of patients might assess the real effectiveness and safety of this procedure.

View Article: PubMed Central - PubMed

Affiliation: Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele-G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy.

ABSTRACT
In the setting of the curative oncological surgery, the gastric surgery is exposed to complicated upper gastrointestinal leaks, and consequently the management of this problem has become more critically focused than was previously possible. We report here three cases of placement of a partially silicone-coated SEMS (Evolution Controlled Release Esophageal Stent System, Cook Medical, Winston-Salem, NC, USA) in patients who underwent total gastrectomy with Roux-en-Y end-to-side esophagojejunostomy for a gastric adenocarcinoma. The promising results of our report, despite the small number of patients, suggest that early stenting (through a partially silicone-coated SEMS) is a feasible alternative to surgical treatment in this subset of patients. In fact, in the treatment of leakage after total gastrectomy, plastic stents and totally covered metallic stents may not adhere sufficiently to the esophagojejunal walls and, as a result, migrate beyond the anastomosis. However, prospective studies with a larger number of patients might assess the real effectiveness and safety of this procedure.

No MeSH data available.


Related in: MedlinePlus

CT scan with gastrographin showing the contrast extravasation.
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fig5: CT scan with gastrographin showing the contrast extravasation.

Mentions: Finally, a 66-year-old man was admitted to our hospital with severe anemia (6 g/dL), abdominal pain, and weight loss. Like in the cases reported above, EGDS showed a gastric lesion, which on histology was revealed to be a gastric adenocarcinoma, and the patient underwent total gastrectomy with Roux-en-Y end-to-side esophagojejunostomy. A stapling esophagojejunostomy was performed, according to the aforementioned procedure. Seven days later, EGDS was performed, due to the onset of severe nausea and fever, showing a 1.8 cm fistula at the anastomosis, about 38 cm from the mouth. This was confirmed by CT scan with gastrografin. The patient was started on TPN and empirical antibiotic (Figure 5) therapy. The abdominal cavity drainage was performed maintaining a drainage tube for 15 days, which was removed; after that the disappearance of the abdominal effusion was demonstrated through abdominal ultrasound. Having deemed clipping treatment for this fistula unfeasible, we decided, also in this patient, to insert a partially silicone-coated SEMS (Evolution Controlled Release Esophageal Stent System). The stent was removed after six weeks. Gastrografin esophagography showed no further contrast extravasation, and EGD showed closure of the fistula. No clinical complications were observed, and the patient was able to start normal per os nutrition 7 days after the stent placement, once an upper X-ray series with gastrografin secured the disappearance of the contrast extravasation.


Self-expandable metal stent placement for closure of a leak after total gastrectomy for gastric cancer: report on three cases and review of the literature.

Raimondo D, Sinagra E, Facella T, Rossi F, Messina M, Spada M, Martorana G, Marchesa PE, Squatrito R, Tomasello G, Lo Monte AI, Pompei G, La Rocca E - Case Rep Gastrointest Med (2014)

CT scan with gastrographin showing the contrast extravasation.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4209762&req=5

fig5: CT scan with gastrographin showing the contrast extravasation.
Mentions: Finally, a 66-year-old man was admitted to our hospital with severe anemia (6 g/dL), abdominal pain, and weight loss. Like in the cases reported above, EGDS showed a gastric lesion, which on histology was revealed to be a gastric adenocarcinoma, and the patient underwent total gastrectomy with Roux-en-Y end-to-side esophagojejunostomy. A stapling esophagojejunostomy was performed, according to the aforementioned procedure. Seven days later, EGDS was performed, due to the onset of severe nausea and fever, showing a 1.8 cm fistula at the anastomosis, about 38 cm from the mouth. This was confirmed by CT scan with gastrografin. The patient was started on TPN and empirical antibiotic (Figure 5) therapy. The abdominal cavity drainage was performed maintaining a drainage tube for 15 days, which was removed; after that the disappearance of the abdominal effusion was demonstrated through abdominal ultrasound. Having deemed clipping treatment for this fistula unfeasible, we decided, also in this patient, to insert a partially silicone-coated SEMS (Evolution Controlled Release Esophageal Stent System). The stent was removed after six weeks. Gastrografin esophagography showed no further contrast extravasation, and EGD showed closure of the fistula. No clinical complications were observed, and the patient was able to start normal per os nutrition 7 days after the stent placement, once an upper X-ray series with gastrografin secured the disappearance of the contrast extravasation.

Bottom Line: In the setting of the curative oncological surgery, the gastric surgery is exposed to complicated upper gastrointestinal leaks, and consequently the management of this problem has become more critically focused than was previously possible.The promising results of our report, despite the small number of patients, suggest that early stenting (through a partially silicone-coated SEMS) is a feasible alternative to surgical treatment in this subset of patients.However, prospective studies with a larger number of patients might assess the real effectiveness and safety of this procedure.

View Article: PubMed Central - PubMed

Affiliation: Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele-G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy.

ABSTRACT
In the setting of the curative oncological surgery, the gastric surgery is exposed to complicated upper gastrointestinal leaks, and consequently the management of this problem has become more critically focused than was previously possible. We report here three cases of placement of a partially silicone-coated SEMS (Evolution Controlled Release Esophageal Stent System, Cook Medical, Winston-Salem, NC, USA) in patients who underwent total gastrectomy with Roux-en-Y end-to-side esophagojejunostomy for a gastric adenocarcinoma. The promising results of our report, despite the small number of patients, suggest that early stenting (through a partially silicone-coated SEMS) is a feasible alternative to surgical treatment in this subset of patients. In fact, in the treatment of leakage after total gastrectomy, plastic stents and totally covered metallic stents may not adhere sufficiently to the esophagojejunal walls and, as a result, migrate beyond the anastomosis. However, prospective studies with a larger number of patients might assess the real effectiveness and safety of this procedure.

No MeSH data available.


Related in: MedlinePlus