Digestive neo-epithelialization after endoscopic stenting for upper digestive tract complete disunion

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Regenerative Medicine

Background:

• Complete digestive disunion from anastomotic necrosis traditionally contraindicates endoscopic repair.
• Emerging evidence suggests endoscopic treatment with self-expandable metal stents (SEMS) is feasible.
• This study evaluates endoscopic management for complete digestive disunion.

Purpose of the Study:

• To demonstrate the efficacy of endoscopic management in selected cases of complete digestive disunion.
• To present a patient series on endoscopic treatment of upper gastrointestinal anastomotic disunion.
• To explore the role of SEMS in facilitating tissue regeneration and lumen restoration.

Main Methods:

• Seven consecutive patients with complete, circumferential upper gastrointestinal anastomotic disunion were treated.
• Endoscopic insertion of SEMS was performed under general anesthesia with CO2 insufflation and fluoroscopic guidance.
• Treatment followed surgical or percutaneous drainage, with stents indwelling for a median of 8 weeks.

Main Results:

• Successful endoscopic SEMS insertion was achieved in all patients.
• Digestive neo-epithelialization and restored gut lumen were observed in all cases.
• Stent migration occurred in 23% of patients, and 43% developed symptomatic strictures treated by dilation.

Conclusions:

• Endoscopic treatment with SEMS is a successful option for selected cases of complete digestive rupture.
• This study provides proof-of-concept for guided tissue regeneration facilitated by SEMS placement.
• Endoscopic management offers a minimally invasive alternative for anastomotic disunion.