Non-operative Management of Delayed Esophagojejunostomy Anastomotic Leak With Endoscopically Placed Stent

Richard Y Greco, DO, Dennis Bordan, MD FACS, Sohail Shaikh, MD, Erwin Douyon, MD. St. Joseph’s Regional Medical Center


Introduction: Gastric ischemia secondary to volvulus is an uncommon entity that is a life-threatening surgical emergency and carries a high morbidity and mortality rate. It typically involves a hiatal hernia. The repair consists of operative reduction with likely resection and esophagojejunostomy anastomosis. Post-operatively, these patients can develop anastomotic leaks, usually because of ischemia.
Discussion: Esophageal anastomotic leaks typically have been managed surgically with multiple staged surgeries and have carried a high morbidity and mortality. Advances in technology and endoscopy have now permitted management of these leaks with fibrin glue, clips, and stents. This is being done with great success and allows non-operative management of these complications.
Conclusion: Prior management of esophageal anastomotic leaks has typically been done surgically with multiple staged operations with high morbidity and mortality. New innovations permit the non-operative management of these complications with little morbidity or complications. Surgeons should be aware of these options and if this is not available to them, great consideration should be made to transferring the patient to an institution that has this technology. In the future, this technology should be made available to institutions that perform esophageal or gastric surgery.

Session Number: Poster – Poster Presentations
Program Number: P196
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