Sato H, Ishida K, Sasaki S, Kojika M, Endo S, Inoue Y, Sasaki A. Regulating migration of esophageal stents - management using a Sengstaken-Blakemore tube: A case report and review of literature. World J Gastroenterol 2018; 24(28): 3192-3197 [PMID: 30065565 DOI: 10.3748/wjg.v24.i28.3192]
Corresponding Author of This Article
Masahiro Kojika, MD, Department of Surgery, Iwate Medical University, School of Medicine, Morioka, Iwate 020-0023, Japan. kojimasa@iwate-med.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hisaho Sato, Masahiro Kojika, Shigeatsu Endo, Yoshihiro Inoue, Department of Critical Care Medicine, Iwate Medical University, School of Medicine, Morioka, Iwate 020-0023, Japan
Kaoru Ishida, Shusaku Sasaki, Masahiro Kojika, Akira Sasaki, Department of Surgery, Iwate Medical University, School of Medicine, Morioka, Iwate 020-0023, Japan
Shigeatsu Endo, Morioka Yuai Hospital, Morioka, Iwate 020-0834, Japan
Author contributions: Sato H, Kojika M, Endo S and Inoue Y designed the report; Ishida K, Sasaki S collected the patient’s clinical data; Sato H, Kojika M and Sasaki A wrote the paper.
Informed consent statement: The patients and their families were offered written explanations prior to the start of the treatment, and they provided consent.
Conflict-of-interest statement: All the authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Masahiro Kojika, MD, Department of Surgery, Iwate Medical University, School of Medicine, Morioka, Iwate 020-0023, Japan. kojimasa@iwate-med.ac.jp
Telephone: +81-19-6515111 Fax: +81-19-6515151
Received: April 19, 2018 Peer-review started: April 19, 2018 First decision: May 30, 2018 Revised: June 17, 2018 Accepted: June 27, 2018 Article in press: June 27, 2018 Published online: July 28, 2018 Processing time: 99 Days and 20.6 Hours
ARTICLE HIGHLIGHTS
Case characteristics
Using a fully covered self-expandable metallic stent (FSEMS) and Sengstaken-Blakemore tube (SBT) is a therapeutic method for correcting stent migration and regulating the complete migration of the stent into the stomach without the patient undergoing endoscopic rearrangement of the stent. It was effective for positioning a stent crossing the esophagogastric junction (EGJ).
Clinical diagnosis
The diagnoses were postoperative suture failure and perforation due to acute esophageal necrosis.
Differential diagnosis
When Case 2 was hospitalized, treatment was started under the suspicion of cardiovascular disease.
Laboratory diagnosis
In terms of the data before starting stent therapy, Case 1 had a white blood count of 7260 μL, CRP level of 11.8 mg/dL, and procalcitonin level of 1.5 ng/mL. Pseudomonas species were detected from the drain. Case 2 had a white blood cell count of 9850 μL, CRP level of 43.3 mg/dL, and procalcitonin level of 7.7 ng/mL. Klebsiella species were detected in the drain fluid sample.
Imaging diagnosis
Case 1 had contrast leakage from the suture site. Case 2 had a pneumothorax found on a computed tomography scan. An esophagogastroduodenoscopy revealed a blackened mucosal lesion, and perforations were found from the central to the lower part of the esophagus.
Pathological diagnosis
No pathological examination was performed.
Treatment
A FSEMS was used for the stent therapy, and stent migration was controlled using a SBT.
Related reports
No reports have described stent management using a SBT for esophageal perforation.
Term explanation
SBTs are generally used to control bleeding from esophageal varices. Acute esophageal necrosis is a rare syndrome characterized by esophageal mucosa with a diffuse blackened appearance, and tends to occur in the distal one-third of the esophagus.
Experiences and lessons
This treatment is effective for positioning stents that cross the EGJ in distal esophageal perforation.
