Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Clinical Outcomes of Endoscopic Metal Stent Placement for Esophagojejunostomy Leakage After Total Gastrectomy for Gastric Adenocarcinoma

Lee, Sung Ryol MD*; Kim, Hyung Ook MD, PhD*; Park, Jung Ho MD, PhD; Yoo, Chang Hak MD, PhD*

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: April 2018 - Volume 28 - Issue 2 - p 113–117
doi: 10.1097/SLE.0000000000000513
Original Articles

Objective: Management of esophagojejunostomy leakage (EJL) has a high mortality rate and increases length of hospital stay. The aim of this study was to evaluate the feasibility of early postoperative gastroduodenoscopy and stent insertion to control EJL after total gastrectomy for gastric adenocarcinoma.

Patients and Methods: Among 421 patients, 13 exhibited EJL. Of the 13 patients, 8 were treated with a covered self-expandable metal stent (SEMS) inserted by endoscopy and 5 patients were treated with surgery or conservative treatment.

Results: The mortality rate was 0% in the SEMS-treated group. The median duration from primary surgery to discovery of leakage was 3.00 days overall [interquartile range (IQR), 2.00 to 5.50 d]. The time to enteral feeding after operation was 24.00 days (IQR, 18.00 to 31.00 d). Median postoperative hospital days was 35.0 days (IQR, 21.00 to 65.00 d). Median duration from leakage to gastroduodenoscopy was 7.00 days (IQR, 1.25 to 14.50 d). On endoscopic findings, most sizes of leakage site were 25% or smaller (8/9, 88.9%) within whole anastomosis size. Eight patients were treated by SEMS. No endoscopic procedure-related or leakage-related deaths occurred.

Conclusions: The promising results for endoscopic treatment in this study showed that early endoscopic treatment using a covered SEMS for EJL might be a feasible, safe, and effective method in selected patients.

Departments of *Surgery

Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

The authors declare no conflicts of interest.

Reprints: Chang Hak Yoo, MD, PhD, Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Republic of Korea (e-mail:

Received August 24, 2017

Accepted January 18, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.