The Temporary Placement of Covered Self-Expandable Metal Stents to Seal Various Gastrointestinal Leaks after Surgery
A 55-year-old male underwent laparoscopic transhiatal esophagectomy with a cervical esophagogastrostomy because of submucosa-invasive esophageal cancer. Pneumonia and a wound infection developed, and intensive care for the complications followed. Eight days after the surgery, exudative discharge was observed at the cervical drainage site. Endoscopic examination was performed 4 weeks after the surgery because the patient's vital signs were unstable, and it revealed a 1.4-cm fistula opening with necrotic material at the esophagogastrostomy, 17 cm from the incisors. We applied a fully covered stent with a funnel-shaped proximal flange (Choo Cervical Stent cervical type, 1.8×8.0 cm; M. I. Tech Co., Ltd.) because the fistula was very close to the upper esophageal sphincter (). Silk threads that were attached to the upper edge of the stent were successfully fixed to the patient's earlobe. Oral feeding was started 5 days after the insertion of the stent. Three weeks after the insertion, a radiocontrast study still revealed minor leakage. Thus, the stent was maintained for an additional 2 weeks and then removed. The patient improved and remained in good condition for 1 year.