USEFULLNESS OF TEMPORARY SELF-EXPENDABLE METALLIC STENT PLACEMENT IN POST-GASTRECTOMY COMPLICATIONS

The self-expandable metallic stent (SEMS) in upper gastrointestinal (GI) tract has been used for palliative treatment of malignant esophageal or gastroduodenal outlet obstruction and fistula. Recently, the use of SEMS is expanded to the benign esophageal or gastroduodenal strictures and postoperative complication. However, there are scarce data available regarding efficacy, long-term complications and outcomes with use of SEMS in benign disease, especially post-gastrectomy complications. We retrospectively analyzed 57 patients who underwent a self-expandable metallic stent insertion in upper GI tract for postoperative complications between March 2009 and June 2017.All patients underwent curative gastrectomy for gastric cancer. Data collected included patient demographics, indication for procedure, type of stent used, complications, and patient outcomes. SEMSs placement was technically successful in all patients. Of 57 patients, 33 patients had SEMS placed for anastomosis site leakage, 12 for anastomosis site refractory stricture, and 12 for obstruction due to angulation, such as E loop or A loop syndrome. After SEMS placement, symptomatic improvement was achieved in 56 of 57 patients (98.2%). Among 56 patients with symptomatic improvement, 3 patients (5.4%) had recurrent symptom; Two patients underwent repeated additional stent insertion and one patient underwent balloon dilatation, respectively. After SEMS placement, mean timing of initiating diet was median 6th day (rang 1-30), and mean duration of hospitalization was median 13 days (range 3-135 days). At 24.6 month mean follow-up, migration was most common reported complication, and developed in 15 (26.3%) patients. SEMS placement is effective and safe treatment for post-gastrectomy anastomosis site leaks, stricture and obstruction due to E loop or A loop syndrome. It can lead to decrease burden and risk of re-operation related mortality and modalities.Clinical outcomes and complications according to the indications.View Large Image Figure ViewerDownload Hi-res image Download (PPT)