Three-tube method and covered metallic stent for the treatment of anastomotic leakage after esophagectomy
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RESEARCH ARTICLE
Open Access
Three-tube method and covered metallic stent for the treatment of anastomotic leakage after esophagectomy Yonghua Bi†, Zhengyang Wu†, Mengfei Yi, Xinwei Han*
and Jianzhuang Ren*
Abstract Background: Anastomotic leakage is common and life-threatening complication after esophagectomy. The management of esophageal anastomotic leakage remains challenging. We aimed to determine the safety, feasibility and efficacy of three-tube method and covered metallic stent placement for the management of anastomotic leakage. Methods: Twenty-six consecutive patients with anastomotic leakage were treated using three-tube method and covered metallic stent and the medical records were retrospectively assessed. All patients received placement of abscess drainage tube, jejunal feeding tube and gastrointestinal decompression tube as well as esophageal covered stent, followed by continue abscess drainage, nutritional support and anti-inflammatory treatment. Tubes and esophageal stents will be removed once anastomotic leakage heals. Results: The procedure was technically successful in 23 patients (95.8%). A total of 31 covered stents were used. Esophageal stents and abscess drainage tubes were successfully removed from 14 patients. The median retention duration was 2.3 months and 2.6 months for stent and abscess drainage tubes, respectively. No perioperative death, esophageal rupture, massive hemorrhage, or other severe complications were observed during procedures. The abscess cavity had markedly decreased in 8 patients or disappeared in 16 cases. During follow-up, 8 patients died of cancer recurrence and 2 patients died of severe pulmonary infection. The 1-, 3-, 5-year survival rates were 60.1, 51.5 and 51.5%, respectively. Conclusion: Three-tube method and covered metallic stent placement is safe, feasible and efficacious for treatment of anastomotic leakage after esophagectomy. Keywords: Anastomotic leakage, Esophageal stent, Drainage, Three-tube method
Background Anastomotic leakage is a rare but life-threatening complication of esophagectomy for esophageal cancer or esophagogastric carcinoma [1, 2], with an overall mortality rate of 20 to 50% [3–6]. Contamination in the abscess cavity may corrode vessels and even result in a higher * Correspondence: [email protected]; [email protected] BYH and WZY share co-first author. † Yonghua Bi and Zhengyang Wu contributed equally to this work. Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou 450052, China
mortality [7]. Various conservative treatment protocols have been used for the management of anastomotic leakage over the past two decades, including the application of biodegradable fistulae plugs or fibrin glue, endoscopic transluminal drainage or clipping and metallic esophageal stent insertion [4, 8–10]. Despite these modalities, management of anastomotic leakage remains challenging and the optimal treatment protocol need to be determined [2, 4, 11].
© The Author(s). 202
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