Endoscopic Stent for Anastomotic Leakage Treatment Post Proximal Gastrectomy in Gastric Cancer: A Case Report

The management of gastrointestinal anastomotic leaks post surgery is a considerable challenge, characterized by elevated morbidity and mortality, particularly in cases of esophageal-jejunal anastomotic leaks. Diverse endoscopic intervention techniques have been utilized with enhanced success. We present a case where a 57-year-old patient with Siewert type II esophageal cardia cancer underwent endoscopic deployment of a fully covered stent into a fistula resulting from anastomotic leakage, following a laparoscopic proximal gastrectomy with Roux-en-Y and double tract reconstruction. On the third day following surgery, the patient demonstrated significant respiratory distress and spat milky sputum as a result of anastomotic leakage and ensuing mediastinitis. On the 11th day after surgery, we used an esophagoscopy to insert a completely coated, self-expanding metallic stent, as the fistula was not healing. On postoperative day 54, the patient started taking oral intake and went home. After one month, we endoscopically removed the stent. Esophagoscopy following stent removal demonstrated that the fistula had resolved and the anastomotic leak had healed. This case shows that using a metal stent that can fully cover itself and expand to stop anastomotic leakage after proximal gastrectomy for stomach cancer does work.