Endoscopic management for gastrointestinal leaks, perforations, and fistulae: Technical tips and outcomes

Figure 6 Management of esophageal-jejunal anastomotic leak using a mega stent in a case of post-operative Whipple procedure with total gastrectomy for periampullary carcinoma with contiguous stomach involvement. A: Endoscopic appearance of the anastomotic site, which shows the site of leak (white dotted arrow), efferent jejunal loop opening (yellow solid arrow), afferent jejunal loop opening (black solid arrow) and esophageal-jejunal anastomosis (white solid asterisk); B: Oral contrast study shows visible active leak at the site of anastomosis; C: Under fluoroscopic and endoscopic guidance, a steel guidewire was placed in the efferent limb of the jejunum and stent was loaded on the guidewire; D: A 24 mm × 23 cm mega stent (Niti-S fully covered self-expanding metal stent, Taewoong Medical, South Korea) was deployed in the efferent limb covering the anastomosis site and leak; E: Contrast study showing no leak and contrast flowing into the distal jejunum; F: Repeat endoscopy after 1 week, showing optimally placed stent into the distal jejunum, covering the leak site.