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Vol. 45. Issue 3.
Pages 198-203 (March 2022)
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Vol. 45. Issue 3.
Pages 198-203 (March 2022)
Original article
Use of double-layered covered esophageal stents in post-surgical esophageal leaks and esophageal perforation: Our experience
Uso de prótesis esofágicas cubiertas de doble malla en fístulas esofágicas postquirúrgicas y perforaciones esofágicas: experiencia en nuestro centro
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Patricia Sanz Segura
Corresponding author
patricia.sanz.segura@gmail.com

Corresponding author.
, Jesús Gotor Delso, Paula García Cámara, Eva Sierra Moros, José Val Pérez, María Teresa Soria Santeodoro, Rafael Uribarrena Amezaga
Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Tables (3)
Table 1. Characteristics of the enrolled patients.
Table 2. Indications and characteristics of the prostheses used.
Table 3. Results after FCSEMS placement.
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Abstract
Introduction

The use of esophageal stents for the endoscopic management of esophageal leaks and perforations has become a usual procedure. One of its limitations is its high migration rate. To solve this incovenience, the double-layered covered esophageal stents have become an option.

Objectives

To analyse our daily practice according to the usage of double-layered covered esophageal metal stents (DLCEMS) (Niti S™ DOUBLE™ Esophageal Metal Stent Model) among patients diagnosed of esophageal leak or perforation.

Methods

Retrospective, descriptive and unicentric study, with inclusion of patients diagnosed of esophageal leak or perforation, from November 2010 until October 2018. The main aim is to evaluate the efficacy of DLCEMS, in terms of primary success and technical success. The secondary aim is to evaluate their (the DLCEMS) safety profile.

Results

Thirty-one patients were firstly included. Among those, 8 were excluded due to mortality not related to the procedure. Following stent placement, technical success was reached in 100% of the cases, and primary success, in 75% (n = 17). Among the complications, stent migration was present in 21.7% of the patients (n = 5), in whom the incident was solved by endoscopic means.

Conclusions

According to our findings, DLCEMS represent an alternative for esophageal leak and perforation management, with a high success rate in leak and perforation resolutions and low complication rate, in contrast to the published data. The whole number of migrations were corrected by endoscopic replacement, without the need of a new stent or surgery.

Keywords:
Esophageal stent
Double-layered covered esophageal stent
Post-surgical esophageal leak
Esophageal perforation
Resumen
Introducción

El uso de prótesis esofágicas para el manejo endoscópico de fístulas y perforaciones se ha convertido en un procedimiento habitual. Una de sus limitaciones es su alta tasa de migración. Para resolver esta situación, se ha propuesto el uso de prótesis cubiertas de doble malla.

Objetivos

Analizar nuestra experiencia práctica en el empleo de prótesis esofágicas cubiertas de doble malla (PECDM) (modelo Niti S™ DOUBLE™ Esophageal Metal Stent) en pacientes con fístula o perforación esofágica.

Material y métodos

Estudio retrospectivo, descriptivo y unicéntrico, donde se incluyen pacientes con diagnóstico de fístula o perforación esofágica, desde noviembre 2010 hasta octubre 2018. Como objetivo primario, se evaluará su eficacia en términos de éxito técnico. Como objetivo secundario, se analizará su perfil de seguridad.

Resultados

Se incluyeron inicialmente un total de 31 pacientes, siendo 8 de ellos excluidos por fallecimiento por causas ajenas a la técnica. Se detectó un éxito técnico del 100%, con un éxitoprimario del 75% tras la recolocación de la prótesis. Entre sus complicaciones, la migración ocurrió en un 21,7% de los pacientes (n = 5), resolviéndose vía endoscópica en el 100% de los casos.

Conclusiones

Según nuestros hallazgos, las PECDM suponen una alternativa en el tratamiento de fístulas y perforaciones esofágicas, con una alta tasa de éxito en la resolución de fístulas y baja de complicaciones, en contraste con lo expuesto en las series publicadas. En todos los casos, la migración de la prótesis se resolvió mediante recolocación endoscópica, sin requerir nueva prótesis ni cirugía.

Palabras clave:
Prótesis esofágica
Prótesis esofágica cubierta de doble malla
Fístula esofágica postquirúrgica
Perforación esofágica

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