The Combined Use of Endoluminal Stents and Over-The-Scope Clips for the Management of Post-Esophageal Surgery Leaks

Abstract

Background: Postoperative leakage at the esophagogastric anastomosis is a well-recognized and significant complication following esophagectomy. In the past, treatment options were largely confined to either conservative, nonsurgical management or removal of the gastric conduit with construction of a cervical esophagostomy. Over the last decade, the development of endoluminal stents and endoscopic clipping techniques has provided a less invasive alternative, enabling effective closure of leaks without the need for further surgery and preserving the continuity of the reconstructed esophagus. Methods: This report presents our initial clinical experiences with the combined use of stents and clips. It also reviews up-to-date evidence on patient selection, available stent designs, treatment success rates, procedure-related considerations, and the anticipated role of endoscopic approaches in managing postoperative esophagogastric anastomotic leakage. Results: We report 3 cases who underwent endoscopic management for esophagogastric anastomotic leak with a combination of stent and clips. The success of the procedure was determined on the extent of the defect and source management, which frequently necessitated concurrent drainage and antibiotic therapy. Conclusions: Conservative approaches have become increasingly significant in the treatment of anastomotic leaks following esophageal surgery. Our experience demonstrates that some challenging cases can be treated with a combination of endoscopic therapy methods.

Keywords: anastomotic leak; clips; endoscopic stent; endovacuum therapy; esophageal leak; esophagectomy; fistula; over-the-scope clips.