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Experience with Fully Covered Self-Expandable Metal Stents for Esophageal Leakage in Children
Bettina Lange1, Süha Demirakca2, Georg Kähler3
1Pediatric Surgery, University Medical Center Mannheim, Mannheim, Germany.
Insights
Fully covered self-expandable metal stents (SEMSs) offer a viable treatment for esophageal leakage in infants and neonates. This study shows high success rates, even in emergency cases and preterm infants.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Devices
Background:
- Limited experience exists with fully covered self-expandable metal stents (SEMSs) for treating esophageal leakage in infants and neonates.
- Esophageal leakage in pediatric patients, especially neonates, presents unique challenges due to anatomical and physiological differences.
Purpose of the Study:
- To evaluate the efficacy and safety of fully covered SEMSs for esophageal leakage in pediatric patients.
- To assess the outcomes of SEMS placement in infants and neonates with anastomotic leakage or esophageal perforation.
Main Methods:
- Retrospective study of eight pediatric patients (median age 17 months) treated with fully covered SEMSs for esophageal leakage.
- Four patients were preterm infants; six procedures were emergencies. Stents were placed for anastomotic leakage or perforation.
Main Results:
- Median stent duration was 42 days; 75% of patients required only one stent.
- 88% of patients achieved leakage resolution post-SEMS therapy.
- Preterm infants treated within the first month showed greater relative weight gain (17%) compared to those treated later (2%). Distal stent migration occurred in 50% of cases.
Conclusions:
- Fully covered SEMSs are a successful alternative for treating esophageal leakage in children and preterm infants.
- SEMSs can be used as a primary or secondary treatment, including in emergency situations.
- Off-label use of SEMSs designed for other organs is feasible due to the lack of age-specific devices.
Background:
There is a lack of experience with fully covered self-expandable metal stents (SEMSs) for the treatment of esophageal leakage particularly in infants and neonates.
Methods:
Eight patients (5M, 3F) with a median age of 17 months (range, 1-135 months) who underwent treatment with SEMSs for an anastomotic leakage or perforation of the esophagus were recruited to this retrospective study. Four children were born premature. In six patients the stents were placed primarily as an emergency procedure.
Results:
Median duration of individual stent placement was 42 days (range, 13-72 days). Six out of eight patients (75%) were treated with one stent only. In three preterm infants who had their stents inserted within the first month relative weight gain was 17% compared with 2% in five patients who were treated later in life (p=0.0986). In four cases (50%) distal migration of the stent was observed. Seven out of eight patients (88%) had their leakage resolved after stent therapy.
Conclusions:
Insertion of fully covered SEMSs is an alternative tool for the treatment of esophageal leakage in children and preterm infants, and successful with only one single application in selected cases. It can be used either following previous therapy or as part of an emergency procedure. Because of the absence of manufactured, age-related devices SEMSs that are originally designed for other organs can be applied.
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