Use of Esophageal Stents After Anastomotic Leakage in Surgery for Gastric Adenocarcinoma Case Report and Review of the Literature
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 6, Issue 4
Abstract
Introduction: Radical gastrectomy is the treatment of choice for the treatment of gastric cancer located in the upper third of stomach or in case of diffuse histology or cells in a signet ring. The worst complication after a radical gastrectomy is the leakage of the esophago-jejunal anastomosis, since it considerably increases the morbidity and mortality of the patient. Case Report:Wedescribe our experience after performing a radical gastrectomy for gastric adenocarcinoma in a patient who developed a leakage of the esophago-jejunal anastomosis in the postoperative period. Although he was reoperated, performing reinforcement of the anastomosis and making a feeding jejunostomy, the dehiscence progressed in the following days until it became almost complete. Then, we proceeded to place a digestive endoprosthesis through gastroscopy with good results, allowing the entire defect to heal and being able to be removed without incidents after 8 weeks. Discussion: There are several alternatives after a leakage of the esophago-jejunal anastomosis. Surgical options include reinforcement of the defect, resection and new anastomosis and esophageal exclusion. However, these options increase the morbidity and mortality of the patient and may require a second intervention in a second time to re-establish the transit. In recent years, the use of digestive stents placed by endoscopy in patients with anastomotic leakage after gastrectomy has proved to be a valid treatment option in selected patients. Gastric cancer continues to be one of the malignant neoplasms of the gastrointestinal tract that causes the greatest number of cancer deaths in our days [1]. In patients with gastric cancer in the upper third or whose biopsy has confirmed the presence of a diffuse type adenocarcinoma or signet ring cells, a radical gastrectomy is the treatment of choice [2,3]. However, the dehiscence of esophago-jejunal anastomosis after gastrectomy for cancer is between 3-20% with a mortality of up to 60%, greater after surgical reoperation than by endoscopic management [4,5]. The leakage of this anastomosis supposes an increase of the morbidity, since it is a delay in the beginning of the enteral nutrition increasing the hospital stay. In addition, its management is a challenge for the surgeon, since the surgical options range from reinforcing or redoing the anastomosis to performing an esophageal diversion. In recent years, the use of stents placed by endoscopy have been shown to reduce morbidity and mortality in selected patients, becoming a treatment option in the management of esophageal fistula. Next, we describe the case of a patient who was operated for gastric adenocarcinoma, performing a radical gastrectomy, which presented as acomplication an esophago-jejunal fistula of practically all the circumference resolved by placement of an esophageal stent.
Authors and Affiliations
Mendoza Moreno, Díez Gago, Mínguez García, Enjuto Martínez, Tallón Iglesias, Solana Maoño, Argüello-de Andrés JM
Keywords
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- EP ID EP592376
- DOI 10.26717/BJSTR.2018.06.001391
- Views 161
- Downloads 0
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