Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.262
Peer-review started: September 11, 2020
First decision: September 29, 2020
Revised: October 9, 2020
Accepted: November 21, 2020
Article in press: November 21, 2020
Published online: January 6, 2021
Processing time: 102 Days and 8.6 Hours
Endoscopic approach could effectively manage postoperative anastomotic leakage. Various endoscopic methods have been developed for the treatment of anastomotic leakage.
A 53-year-old woman developed anastomotic leak after laparoscopic proximal gastrectomy. Endoscopic clip closure failed due to strong wall tension; therefore, a fully covered self-expandable esophageal metal stent (fc-SEMS) was placed to cover the leak after it was filled with a mixture of fibrin glue and histoacryl. However, fluoroscopy with gastrograffin showed dye leaking out of the fc-SEMS. Using the previous fluoroscopic image for guidance, a catheter was inserted at the leakage site. The radiocontrast dye was injected and was seen spreading along the sinus tract. Thereafter, histoacryl was injected. Seven days after the last procedure, upper gastrointestinal contrast studies showed no leaks. The patient was subsequently discharged 9 d after histoacryl injection without any complications.
To seal an anastomosis leak after stent application, salvage technique using histoacryl injection at the leakage site with fluoroscopy guidance could be considered cautiously.
Core Tip: Endoscopic treatment including stent deployment, clipping or fibrin glue is considered as a safe and effective treatment options for anastomotic leakage after gastrectomy. We successfully treated esophago-gastric anastomotic leakage with endoscopic salvage treatment of add-on histoacryl after fully covered self-expandable esophageal metal stent (fc-SEMS). Histoacryl injection after fc-SEMS application on the anastomotic leak should be considered as treatment option.