Self-expanding removable plastic stents for the protection of surgical anastomoses after esophageal replacement in a porcine model

• Published in: Gastrointestinal endoscopy 2010-10, Vol.72 (4), p.790-795
• Main Authors: Le Baleur, Yann, MD, Gaujoux, Sébastien, MD, Bruneval, Patrick, MD, PhD, Lambert, Benoît, MD, Larghero, Jérome, MD, PhD, Cattan, Pierre, MD, PhD, Prat, Frédéric, MD, PhD
• Format: Article
• Language: English
• Subjects: Anastomotic Leak - prevention & control; Animals; Aorta - transplantation; Biological and medical sciences; Digestive system. Abdomen; Endoscopy; Esophagus - surgery; Feasibility Studies; Female; Foreign-Body Migration - epidemiology; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Investigative techniques, diagnostic techniques (general aspects); Male; Mediastinitis - etiology; Medical sciences; Models, Animal; Prosthesis Design; Stents; Swine; Transplantation, Homologous
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2010.06.041

Background Esophageal replacement by biological graft is associated with a high risk of anastomotic leak–related mediastinitis. Objective To determine whether a self-expanding plastic stent can help avoid anastomotic leak after full-thickness replacement of the esophagus in a porcine model. Design Experimental feasibility study in a porcine model. Subjects Twelve pigs were analyzed in the study. Interventions Replacement of a 2-cm-long segment of the cervical esophagus by an aortic allograft was performed in 12 pigs, with 6 pigs used as graft donors. Animals were divided into 2 groups depending on whether a self-expanding removable plastic stent protecting the 2 aortoesophageal anastomoses was inserted (n = 7) or not (n = 5), and were allowed to eat 24 hours postoperatively. Main Outcome Measurements The relative occurrence of mediastinitis caused by anastomotic leakage in stented and nonstented groups was assessed; endoscopic evaluation and histological analysis of the graft area were performed 1 month after esophageal replacement. Results All animals (n = 5) without stent insertion died of anastomotic leakage within 20 days of surgery. Two of the 7 stented animals died at day 2, and 5 survived 1 month in good clinical condition. Two stent migrations were noted. Stent extraction was followed by the development of a fibrous stricture. Conclusions The use of a self-expanding plastic stent seems to allow leak-free healing after circumferential replacement of the esophagus by a biological graft in a porcine model.