A Case of Refractory Esophagojejunostomy Leakage Following Esophagogastric Junctional Cancer Surgery Successfully Treated with Endoscopic Placement of an Esophageal Stent

Abstract

In Western countries, use of a fully covered self-expandable metal stent (SEMS) for closure of anastomotic leakage has been widely reported. However, in Japan, this approach is not covered under the national health insurance system, and there are few reports of it use. We report a case of anastomotic leakage following esophagogastric junctional cancer surgery that was successfully managed with endoscopic placement of a fully covered SEMS. The patient was a 49-year-old man who underwent robot-assisted proximal gastrectomy combined with lower esophagectomy for esophagogastric junction cancer. Anastomotic leakage was detected on postoperative day (POD) 2. On POD 9, thoracoscopic and laparoscopic lavage drainage, direct suture repair, and omental patch covering were performed, but recurrent leakage occurred. As inflammation remained poorly controlled, a fully covered SEMS (HANAROSTENT^®, 18×80 mm) was endoscopically placed on POD 27. This resulted in rapid clinical improvement and fistula reduction. The stent was subsequently removed and the patient was discharged on POD 95. Although fully covered SEMS placement is not reimbursed by insurance in Japan, our experience suggests it may be a minimally invasive and effective treatment option for refractory anastomotic leakage.