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Symptomatic Malignant Gastroesophageal Anastomotic Leak

Management with Covered Metallic Esophageal Stents

Shuvro H. Roy-Choudhury1, Anthony A. Nicholson1, Kevin R. Wedgwood2, Richard A. J. Mannion3, Peter C. Sedman2, Christopher M. S. Royston2 and David J. Breen1

1 Department of Radiology, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Rd., Kingston Upon Hull, East Yorkshire, HU3 2JZ, United Kingdom.
2 Department of Surgery, Hull and East Yorkshire Hospitals NHS Trust, Kingston Upon Hull, East Yorkshire, HU3 2JZ, United Kingdom.
3 Department of Radiology, York District Hospital NHS Trust, Wigginton Rd., York, YO31 8HE, United Kingdom.



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  		Fig. 1A. —Contrast-enhanced swallow radiographs of 69-year-old man after total gastrectomy and Roux-en-Y gastrojejunal anastomosis. Anastomotic leak to right pleural space is seen (curved arrow). Efferent limb of end-to-side anastomosis is opacified by contrast agent (straight arrow).

 


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  		Fig. 1B. —Contrast-enhanced swallow radiographs of 69-year-old man after total gastrectomy and Roux-en-Y gastrojejunal anastomosis. No leakage is seen after stenting with covered knitted nitinol stent, and anastomotic site is clearly appreciated (short arrow). Knitted nitinol stent configures closely to postoperative anatomy. Free passage of contrast of efferent limb of anastomosis is seen (straight arrow).

 


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  		Fig. 2. —Supine radiograph of 75-year-old man during contrast-enhanced swallow after stenting of gastroesophageal anastomosis shows "back leak" along side wall of stent from anastomotic line (arrow). No leakage occurred on erect swallow. Patient was rendered clinically asymptomatic after stenting.

 


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  		Fig. 3A. —Contrast-enhanced swallow radiographs of 64-year-old woman after esophageal resection and upper thoracic anastomosis. Significant leakage into high left pleural space is seen (arrow).

 


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  		Fig. 3B. —Contrast-enhanced swallow radiographs of 64-year-old woman after esophageal resection and upper thoracic anastomosis. After fluoroscopically guided subcricopharyngeal stenting, no leakage is seen. This patient lived for 14 months without any stent-related complications.

 

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