The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length.
Treatment of oesophageal anastomotic leaks by temporary
stenting with self-expanding plastic stents (Br J Surg 2009; 96: 887-891)
Sir
We commend the authors on the selection of this important topic and their approach to a serious surgical complication. However, several unanswered questions arise from this study. The authors do not provide details of the leaks they encountered, in particular the severity, extent, nature and specific site of the defects. The literature indicates that the site and subsequent management of upper gastrointestinal anastomotic leaks can vary considerably 1 . Categorization of the leak is essential in determining whether proposed endoscopic treatment is an appropriate option.
In addition, over the 6-year period, the authors seem to have encountered a much lower number of leaks than the experience at a major centre 2 . This raises two concerns: first, was there was an element of selection bias and, second, how many oesophagogastric resections were performed in total and what was the incidence of subsequent anastomotic leaks? These need to be documented to determine the overall leak rate and thus the proportion of cases suitable for self-expanding plastic stents.
The authors demonstrate excellent results in this case series, but it is difficult to determine whether the technical success achieved is related to the intervention itself or is simply a result of case selection. In addition, the study does not address the question of whether these leaks healed despite the authors' intervention or because of it.
Although this represents a novel therapeutic intervention, there may be significant variation in patient factors between centres which would affect the widespread application of this therapy. The authors do not provide details of co-morbidity and other extrinsic factors that would affect management of the leak, and it remains unclear whether this technique is suitable for all types of leaks and in all patient groups.