The Temporary Placement of Covered Self-Expandable Metal Stents to Seal Various Gastrointestinal Leaks after Surgery
A 58-year-old man received a thoraco-laparoscopic esophagectomy with a cervical esophagogastrostomy due to submucosa-invasive esophageal cancer. Hypovolemic shock and acute renal failure occurred 2 days after the surgery, and continuous renal-replacement therapy followed. Three weeks after the surgery, a radiocontrast study revealed leakage from the esophagojejunostomy, and endoscopy revealed a 1.2-cm dehiscence of the anastomosis that was located 18 cm from the incisors (). The radiocontrast that was injected into the working channel of the endoscope was discharged to the cervical drainage. We applied an anti-migration stent with 0.5-cm-wide, uncovered proximal flange and silk threads (CHOOSTENT® esophageal ST, 2.2×12.0 cm; M. I. Tech Co., Ltd.). However, the attempt to perform a fixation to an earlobe failed because the threads were broken during the insertion. A nasojejunal tube (ENBD-7-LIGUORY, 7 Fr, 250 cm; Cook Medical Inc., Winston-Salem, NC, USA) was inserted through the scope for feeding. The stent did not migrate, but a follow-up endoscopy revealed that a fistula was present at the anastomosis site 4 weeks after the insertion of the stent. Repeated endoscopic examination revealed the complete closure of the fistula 7 weeks after the insertion, and the stent was removed (). The patient remained stable over a 1-year follow-up period.