%0 Journal Article
%T Outcomes of the Use of Fully Covered Esophageal Self-Expandable Stent in the Management of Colorectal Anastomotic Strictures and Leaks
%A Chad J. Cooper
%A Angel Morales
%A Mohamed O. Othman
%J Diagnostic and Therapeutic Endoscopy
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/187541
%X Introduction. Colorectal anastomotic leak or stricture is a dreaded complication leading to significant morbidity and mortality. The novel use of self-expandable metal stents (SEMS) in the management of postoperative colorectal anastomotic leaks or strictures can avoid surgical reintervention. Methods. Retrospective study with particular attention to the indications, operative or postoperative complications, and clinical outcomes of SEMS placement for patients with either a colorectal anastomotic stricture or leak. Results. Eight patients had SEMS (WallFlex stent) for the management of postoperative colorectal anastomotic leak or stricture. Five had a colorectal anastomotic stricture and 3 had a colorectal anastomotic leak. Complete resolution of the anastomotic stricture or leak was achieved in all patients. Three had recurrence of the anastomotic stricture on 3-month flexible sigmoidoscopy follow-up after the initial stent was removed. Two of these patients had a stricture that was technically too difficult to place another stent. Stent migration was noted in 2 patients, one at day 3 and the other at day 14 after stent placement that required a larger 23£żmm stent to be placed. Conclusions. The use of SEMS in the management of colorectal anastomotic leaks or strictures is feasible and is associated with high technical and clinical success rate. 1. Introduction Anastomotic adverse events after partial colectomy include bleeding, leaks, fistulas, or strictures. Anastomotic leaks or strictures are a dreaded adverse event of colorectal surgery that can lead to a prolonged hospital stay and significant morbidity and mortality. An anastomotic leak is defined as a defect of the intestinal wall at the anastomotic site leading to a communication between the intra/extraluminal compartments [1]. The risk varies with the site of the anastomosis with those placed less than 5 centimeters (cm) from the anal verge being particularly vulnerable [2]. The incidence of an anastomotic leak depends on the location of the anastomosis with the highest incidence of 10¨C20% occurring with colorectal anastomosis [3]. The majority of patients suspected of having an anastomotic leak based on clinical assessment will undergo imaging studies to confirm the diagnosis. The usual approach for management of postoperative anastomotic leaks includes intravenous antibiotics, bowel rest, percutaneous drainage, parenteral nutrition, and surgical diversion [4]. The patient may require reoperation that consists of taking down the anastomosis and creation of an end colostomy. The distal portion
%U http://www.hindawi.com/journals/dte/2014/187541/