Conservative reconstruction using stents as salvage therapy for disruption of esophago-gastric anastomosis

Figure 1 Computed tomography findings of the anastomosis and mediastinum. A: Continuity of the anastomosis, no evidence of malformation of the staple line, and no fluid or air surrounding the anastomosis were observed on postoperative day (POD) 6 (arrows); B: Computed tomography findings on POD 21 showed disruption of the anastomosis and malformation of the anastomotic staples and mediastinal cavity.

Figure 2 Findings of the oral contrast studies over time. A: Complete extravasation of the entire volume of contrast medium into the mediastinal cavity (arrows); B: Complete occlusion of the leakage by self-expanding metal stent (SEMS) placement; C: Complete flow of the contrast medium without leakage or stenosis after the SEMS was removed.

Figure 3 Endoscopic findings of gastric conduit necrosis and self-expanding metal stent placement. A: The stump of the healthy gastric conduit (thick white arrows) and the staple in the stump of the gastric conduit (thin black arrow); B: Complete disruption of 2 cm of the anastomosis and stump of the gastric conduit (thick white arrows); C: Placement of a removable covered self-expanding metal stent (SEMS); D: A silk thread placed through the lasso located on the proximal end of the stent.

Figure 4 Hanarostent fully covered esophageal stent (M. i.tech Co., 24/18 mm in diameter and 10 cm in length) and lasso (A) and Fixation of the stent to the patient’s ear by placing a silk thread through the lasso to prevent stent migration (B).

Figure 5 Endoscopic findings of the anastomosis after removal of the self-expanding metal stent and staple in the stump of the gastric conduit (thin black arrow). A: Easy removal of the self-expanding metal stent without complications; B: Complete reconstruction of a new anastomosis with granulation tissue; C, D: Progression of epithelialization of the new anastomosis without stenosis over time (PSDs 65 and 84).