Related Experiment Video
Updated: Jun 12, 2026
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Proximal-releasing stent insertion under transnasal endoscopic guidance in patients with postoperative esophageal
Kee Myung Lee1, Sung Jae Shin, Jae Chul Hwang
1Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea.
Background:
Covered metallic or plastic stent placement has become an important treatment for postoperative esophageal leakage; however, fluoroscopic guidance is also required. Here we present a novel stent insertion technique with a newly designed proximal-releasing, self-expanding metallic stent (PR-SEMS) and transnasal endoscope that can enable stent insertion without fluoroscopy as a new method to prevent stent migration.
Objective:
To describe our experience with 7 patients who underwent PR-SEMS insertion with the direct-vision technique and our use of the transnasal endoscope without fluoroscopy.
Design:
Prospective outcome study.
Setting:
A tertiary-care referral university hospital.
Patients:
This study involved all patients at our center who experienced postoperative esophageal leakage after esophagectomy, primary closure, or total gastrectomy.
Intervention:
PR-SEMS insertion with the direct vision technique and use of transnasal endoscopy without fluoroscopy.
Main Outcome Measurements:
Success rate of stent insertion, healing rate of postoperative esophageal leaks, and stent migration rate.
Results:
All stents were placed at the expected location without complications. One patient had massive hematemesis and underwent surgery. The bleeding focus was the splenic artery, which was damaged during gastrectomy. A significant marginal ulcer occurred in one patient, and the stent was immediately retrieved with an endoscope. After stent removal, 4 postoperative leakages were completely healed, and 2 lesions were not occluded. The 2 remaining minimal lesions became completely occluded with conservative management after stent removal. Stent migration did not occur.
Limitations:
A small number of patients. Further prospective, randomized, controlled trials are needed.
Conclusion:
PR-SEMS insertion under transnasal endoscopic guidance is a feasible, safe, and effective treatment for postoperative esophageal leakage, and it can be performed as a bedside procedure. Our anchoring method is effective for the prevention of migration from nonobstructed lesions.
More Related Videos
Related Concept Videos
01:29Endoscopic Procedures I: Esophagogastroduodenoscopy
During an EGD, the endoscope can be used to:
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:30Endoscopic Studies I: Bronchoscopy and Thoracoscopy
Bronchoscopy
Description
Bronchoscopy is a procedure that involves direct visualization of the larynx, trachea, and bronchi for diagnostic and therapeutic purposes. A flexible fiber optic or rigid bronchoscope is used to carry out the procedure. The fiber-optic bronchoscope is more frequently used due to...
01:26Endoscopic Procedures V: ERCP
Patient...
01:30Esophageal Strictures-I: Introduction
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...