Endoscopic application of clipping, over-the-scope clip (OTSC) and stenting for a fistula and anastomotic leakage of upper gastro- intestinal tract

Abstract

After esophagectomy and total gastrectomy, anastomotic leakage is a serious complication associated with a high mortality. Complications such as abscesses, sepsis and malnutrition may occur. In cases of anastomotic leakage after esophagectomy and gastrectomy, occurrence of an esophago-respiratory fistula or pancreatic fistula can be a very dangerous, even fatal complication. Various endoscopic techniques have been recently developed to treat leakage and fistula using minimally invasive approaches. Treatment methods including techniques such as fibrin glue injection, use of clips or self-expandable stents which are more conservative than surgery have become available. We report successful endoscopic clipping and application of fibrin glue, which is more conservative than surgery, for an esophago-mediastinal fistula. In addition to reporting endoscopic application of transnasal tube, over-the-scope clip (OTSC) and stenting, we also performed clipping for difficult cases with leakage or fistula. In this paper, indications of these endoscopic therapeutic methods are described for each case. With a broad range of conservative and endoscopic therapeutic methods available, encouraging progress has been made with regards to a shorter closure time of leakage and less risk of severe systemic complications. *Correspondence to: Hiroshi Makino, Department of Surgery, Tama Nagayama Hospital, Nippon Medical School, 1-7-1 Nagayama, Tama-City, Tokyo, Japan206-8512, Tel: +81-42-371-2111, Fax +81-42-372-7384, E-mail: himiyumo@nms.ac.jp