An Assessment of the Optimal Time for Removal of Esophageal Stents Used in the Treatment of an Esophageal Anastomotic Leak or Perforation

• Published in: The Annals of thoracic surgery Vol. 100; no. 2; pp. 422 - 428
• Main Authors: Freeman, Richard K., MD, MBA, Ascioti, Anthony J., MD, Dake, Megan, PA-C, Mahidhara, Raja S., MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.08.2015
• Subjects: Adult; Aged; Aged, 80 and over; Anastomotic Leak - surgery; Cardiothoracic Surgery; Device Removal - standards; Esophageal Perforation - surgery; Esophagus - surgery; Humans; Middle Aged; Retrospective Studies; Stents; Surgery; Time Factors; Young Adult
• DOI: 10.1016/j.athoracsur.2015.03.085
• ISSN: 0003-4975

Background Esophageal stent for the treatment of a perforation or anastomotic leak has been shown to be effective and safe. However, the optimal timing for stent removal is in question. This purpose of this investigation was to identify a time for stent removal in patients treated for an acute perforation or anastomotic leak that resulted in sealing of the leak while minimizing the incidence of stent-related complications. Methods Patients undergoing esophageal stent placement for the treatment of an acute perforation or intrathoracic anastomotic leak were identified from a single institution’s prospectively collected database. Patient outcomes were recorded and analyzed. Complications were segregated by stent dwell time. Results During the study period, 162 patients underwent esophageal stent placement for an acute perforation (n = 117) or anastomotic leak (n = 45). Patients whose stent was removed in less than 28 days after placement for an acute perforation realized a stent complication rate that was independently reduced by 39% (odds ratio, 0.61; 95% confidence interval, 0.54 to 0.78; p < 0.01), whereas patients whose stent was removed in less than 14 days after placement for an acute perforation realized a stent complication rate that was independently reduced by 56% (odds ratio, 0.44; 95% confidence interval, 0.38 to 0.69; p < 0.001). Conclusions Endoluminal esophageal stent placement is a safe and effective treatment for patients with an acute esophageal perforation or intrathoracic anastomotic leak after esophagectomy. Removal of stents at 2 weeks for anastomotic leak or 4 weeks for perforation has the potential to significantly decrease the incidence of complications associated with stent use.