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Self-expanding metal stents or nonstent endoscopic therapy: which is better for anastomotic leaks after total gastrectomy?

Authors
 Choong Nam Shim  ;  Hyoung-Il Kim  ;  Woo Jin Hyung  ;  Sung Hoon Noh  ;  Mi Kyung Song  ;  Dae Ryong Kang  ;  Jun Chul Park  ;  Hyuk Lee  ;  Sung Kwan Shin  ;  Yong Chan Lee  ;  Sang Kil Lee 
Citation
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol.28(3) : 833-840, 2014 
Journal Title
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 
ISSN
 0930-2794 
Issue Date
2014
MeSH
Adenocarcinoma/mortality ; Adenocarcinoma/surgery ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects ; Anastomotic Leak/mortality ; Anastomotic Leak/surgery* ; Endoscopy, Gastrointestinal/methods* ; Female ; Follow-Up Studies ; Gastrectomy/adverse effects* ; Humans ; Male ; Middle Aged ; Prosthesis Design ; Reoperation ; Republic of Korea/epidemiology ; Retrospective Studies ; Stents* ; Stomach Neoplasms/mortality ; Stomach Neoplasms/surgery* ; Survival Rate/trends ; Treatment Outcome
Keywords
Anastomotic leaks ; Total gastrectomy ; Self-expanding metal stent ; Endoclip ; Fibrin glue
Abstract
BACKGROUND: Anastomotic leaks are a life-threatening complication of gastrectomies with high mortality after surgical reintervention. Endoscopic therapy using fibrin glue injection, endoclip, and other devices is an alternative to surgical intervention for anastomotic leaks. Recently, self-expanding metal stents (SEMS) were introduced to treat anastomotic leaks. The purpose of this study was to assess the clinical characteristics and therapeutic outcomes of SEMS and nonstent endoscopic therapy (NSET) for treatment of anastomotic leaks after total gastrectomy with the aim of assisting endoscopists in choosing a treatment method. METHODS: Between July 2002 and March 2013, 13 patients treated with SEMS and 14 patients treated with NSET for anastomotic leaks after total gastrectomy were enrolled onto the study. Enrolled patients received 16 SEMS placement sessions and 21 NSET sessions. RESULTS: No significant differences in baseline characteristics or clinical characteristics related to leakage were detected in patients with SEMS compared to NSET. The successful sealing rate at the first attempt by SEMS was significantly better than that of NSET (80.0 vs. 28.6 %, P = 0.036), whereas the successful sealing rate after multiple endoscopic treatments was not statistically different (80.0 vs. 64.3 %, P = 0.653). The main reason for reintervention with SEMS was complications and with NSET was nonseal (P = 0.004). Clinical outcomes including length of hospital stay, endoscopic treatment-related mortality, and all-cause mortality were not significantly different between the 2 groups. CONCLUSIONS: In terms of efficacy by single effort, SEMS was superior to other methods for treating anastomotic leaks after total gastrectomy. However, complications with SEMS should be considered when choosing an endoscopic treatment method.
Full Text
http://link.springer.com/article/10.1007%2Fs00464-013-3228-5
DOI
10.1007/s00464-013-3228-5
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Dae Ryong(강대용)
Kim, Hyoung Il(김형일) ORCID logo https://orcid.org/0000-0002-6134-4523
Noh, Sung Hoon(노성훈) ORCID logo https://orcid.org/0000-0003-4386-6886
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Song, Mi Kyung(송미경)
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Shim, Choong Nam(심충남)
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Lee, Hyuk(이혁)
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/98180
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