Endoscopic multiple metal stenting for the treatment of enteral leaks near the biliary orifice: A novel effective rescue procedure

Table 1 Case series

Patient (yr/gender)	Original procedure	Indication to treat	Treatment protocol	Success (days to obtain fistula closure)	Removal	F/u (mo)
1 (66/F)	Whipple's procedure for pancreatic adeno Ca	Dehiscence of the bilio-enteric anastomosis	FCESEMS (8 cm × 20 mm) + FCBSEMS (4 cm × 10 mm)	Yes (3)	En bloc endoscopic removal 8 wk later	28
2 (57/M)	Whipple’s procedure with pancreatic nelaton tube for main duct IPMN	Dehiscence of the bilioenteric and the pancreatico-jejunal anastomosis	FCESEMS (8 cm × 20 mm) + FCBSEMS (4 cm × 8 mm) + positioning of nelaton tube into enteral stent + FCESEMS (8 cm × 20 mm)	Yes after second stenting (1)	First enteral stenting induced a jejunal perforation A 2nd enteral stenting was performed All stents removed endoscopically 6 wk later	24
3 (72/M)	Nephrectomy Liver transplantation 5 yr ago	Duodenal leak after rupture of infected perirenal hematoma	FCESEMS (10 cm × 20 mm) + FCBSEMS (6 cm × 10 mm) + Pancreatic plastic stent (7 Fr × 7 cm)	Pre-existing sepsis Patient died 48 h after procedure	N/A	N/A
4 (68/M)	Right nephrectomy, adrenalectomy and right colectomy for retroperitoneal liposarcoma	Duodenal fistula	FCESEMS (12 cm × 20 mm) (12 cm × 20 mm) + FCBSEMS (6 cm × 8 mm) (4 cm × 10 mm) + Pancreatic plastic stent (7 Fr × 7 cm)	Yes after removal of second set of stents (1)	Stents removed surgically due to migration causing enteral obstruction New stents re-inserted a few days later which were removed endoscopically 4 wk later	18
5 (51/M)	Distal duodenal wedge resection for duodenal adenoma with focal adenocarcinoma	Dehiscence of duodenal suture + Biliary fistula at previous T tube placement site	FCESEMS (10 cm × 20 mm) + FCBSEMS (6 cm × 10 mm) + Pancreatic plastic stent (7 Fr × 7 cm)	Yes (1)	All stents removed endoscopically 4 wk later	36
6 (56/F)	Cholecystectomy	Duodenal fistula-Duodenal wall erosion from surgical drain	FCESEMS (10 cm × 24 mm) + FCBSEMS (6 cm × 10 mm) + Pancreatic plastic stent (7 Fr × 7 cm)	Yes (1)	All stents removed endoscopically 8 wk later	6