Saraiva M, Conceição D, Gomes LC, Garcia JL, Currais P, Simões C, Moleiro J, Lage P, Ramos P, Monteiro C, Casaca R, Rosa I. Management of anastomotic leakage in upper gastrointestinal tract after oncologic surgery: Role of fully covered metallic stents. World J Gastroenterol 2026; 32(32): 119202 [DOI: 10.3748/wjg.119202]
Corresponding Author of This Article
Margarida Saraiva, MD, Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, Lisbon 1099-023, Portugal. asaraiva@ipolisboa.min-saude.pt
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Gastroenterology & Hepatology
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Saraiva M, Conceição D, Gomes LC, Garcia JL, Currais P, Simões C, Moleiro J, Lage P, Ramos P, Monteiro C, Casaca R, Rosa I. Management of anastomotic leakage in upper gastrointestinal tract after oncologic surgery: Role of fully covered metallic stents. World J Gastroenterol 2026; 32(32): 119202 [DOI: 10.3748/wjg.119202]
World J Gastroenterol. Aug 28, 2026; 32(32): 119202 Published online Aug 28, 2026. doi: 10.3748/wjg.119202
Management of anastomotic leakage in upper gastrointestinal tract after oncologic surgery: Role of fully covered metallic stents
Margarida Saraiva, Daniel Conceição, Luís Correia Gomes, Joana Lemos Garcia, Pedro Currais, Carolina Simões, Joana Moleiro, Pedro Lage, Paulo Ramos, Cecília Monteiro, Rui Casaca, Isadora Rosa
Margarida Saraiva, Daniel Conceição, Luís Correia Gomes, Joana Lemos Garcia, Pedro Currais, Carolina Simões, Joana Moleiro, Pedro Lage, Isadora Rosa, Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon 1099-023, Portugal
Paulo Ramos, Cecília Monteiro, Rui Casaca, Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon 1099-023, Portugal
Co-corresponding authors: Margarida Saraiva and Isadora Rosa.
Author contributions: Saraiva M and Rosa I contributed equally to this study as co-corresponding authors; Saraiva M, Conceição D, and Rosa I were responsible for conceptualization; Saraiva M, Conceição D, Garcia JL, Simões C, Currais P, and Moleiro J were responsible for data acquisition; Saraiva M, Lage P, Monteiro C, Ramos P, and Casaca R were responsible for data analysis and interpretation; Saraiva M and Conceição D were responsible for original draft preparation; Gomes LC and Rosa I were responsible for review and editing.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Instituto Português de Oncologia de Lisboa Francisco Gentil (Approval No. UIC/1781).
Informed consent statement: Patient consent was not required for this study due to its retrospective, observational nature.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Corresponding author: Margarida Saraiva, MD, Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, Lisbon 1099-023, Portugal. asaraiva@ipolisboa.min-saude.pt
Received: January 21, 2026 Revised: February 22, 2026 Accepted: June 4, 2026 Published online: August 28, 2026 Processing time: 193 Days and 10.3 Hours
Abstract
BACKGROUND
Upper gastrointestinal anastomotic leakage (AL) is a life-threatening condition with high mortality rates and one of the most feared complications following surgery. Due to its challenging clinical management, a multidisciplinary approach is recommended. In the last decades, endoscopic devices and technical advancements have provided less invasive therapeutic alternatives to surgery. However, evidence on the best approach is still lacking. This study investigated the efficacy of fully covered self-expandable metallic stents (FCSEMS) in upper gastrointestinal tract AL management, in the oncology setting.
AIM
To evaluate the clinical effectiveness of FCSEMS in managing upper gastrointestinal AL after oncologic surgery.
METHODS
A retrospective cohort study was conducted at a tertiary care hospital. From December 2013 to December 2023, all consecutive patients who developed AL after upper gastrointestinal oncologic surgery and were treated with FCSEMS were included in the study. We analyzed clinical data, leakage characteristics, FCSEMS technical and clinical success, stent-related complications, and mortality.
RESULTS
A total of 70 patients (80% male, median age 65.5 years) were included. Surgery was performed due to esophageal (25.7%), esophagogastric junction (47.1%), and gastric (27.1%) cancers. Neoadjuvant treatment was administered in 68.6% patients; Ivor-Lewis esophagectomy (30%), McKeown esophagectomy (22.9%), and total gastrectomy (42.9%) were the most common surgeries. Intensive care unit admission occurred in 48.6%, and external drainage in 88.6%. Leakage size was < 20 mm in 80%; neoadjuvant therapy was associated with larger leaks (P = 0.029). Stent migration occurred in 31 cases. The average number of FCSEMS per patient was 1.5 (1-4); neoadjuvant therapy was associated with a higher number of stents (P = 0.011). Technical success was achieved in 95.7% of cases, with clinical success in 57 (81.4%) patients.
CONCLUSION
FCSEMS offer effective management of AL in the upper gastrointestinal tract. Specifically for oncological AL, their placement should be considered due to their high technical and clinical success rates.
Core Tip: Anastomotic leakage following upper gastrointestinal oncologic surgery is a life-threatening condition, for which optimal treatment is still not standardized. Fully covered self-expandable metallic stents are a validated endoscopic option with which our center has long-term experience. We retrospectively reviewed all patients treated with this modality (n = 70), from 2013 to 2023, and our findings demonstrate its effectiveness in the management of anastomotic leaks in oncological patients.
