Keywords:
Gastrointestinal tract
Authors:
A. J. Swift, W. H. K. CHIU, A. Razack; Hull/UK
DOI:
10.1594/ecr2010/C-3312
Methods and Materials
We present four cases of oesophageal leaks/perforations treated by injection of fibrin-glue sealant and covered stent.
The patient is positioned in a left lateral position and is sedated. A 5F KMP catheter with a short angled tip is passed per oral and the site of leak is identified with injection of non-ionic contrast. Under flouroscopic control, the neck of the leak is entered with hydrophilic coated wire with catheter guidance (75 cm 5F KMP, Cook, Bloomington, Ind). The catheter is advanced over the wire through the neck. On slow withdrawal of the catheter, the fibrin-glue is hand injected to plug the tract at approximately around 1ml/sec. A total of 10ml (5/5ml) of fibrin glue is injected. Following this injection, some of the sealant sets within the cathter and so this catheter is then removed and another catheter is inserted. Using furthur contrast through this catheter, a check is made for assessment of closure of leak. A removable covered metallic stent SX–ELLA HV oesophageal stent (ELLA-CS. Company, Hradec Kralove, Czech Republic) is then inserted over a guidewire to cover the leak site. The patient returns the following day for a repeat water soluble contrast swallow to check for any remaining leak. The patient is then allowed oral feed. The stent is subsequently removed via an endoscope after six to eight weeks.