Endoscopic treatment of esophagojejunostomy dehiscence after total gastrectomy with a fully covered self-expandable metallic stent
Epublication WebSurg.com, May 2009;09(05). URL: http://websurg.com/doi/vd01en2644
The most frequent complications after upper GI surgery are leaks and stenosis. These complications are associated with significant morbidity and mortality rates. Conservative treatments such as Self-Expanding Metal Stents (SEMS) and balloon dilatation have been described for the treatment of these complications, but stay controversial yet. We report a case of a 66-year-old woman who underwent a total gastrectomy for a neuro-endocrine tumor that developed an anastomotic dehiscence six days after surgery, successfully treated with a covered SEMS. The stent was well-tolerated and left in place for two weeks. Its ablation confirmed through endoscopic and enhanced X-ray upper series the development of a granulation tissue, along with epithelial proliferation, enough to produce a perfectly closed and healing anastomotic defect. No further surgery was required; oral feeding was started and has been well-tolerated and the patient was soon discharged. In this case where the use of surgery seemed inevitable and not risk-free, the placement of a removable SEMS was demonstrated to be a safe and efficient technique.