Mucosal incision-assisted closure with clips for esophageal anastomotic leak.

Abstract

A 67-year-old male was admitted to our hospital with a diagnose of a <1-cm clear dehiscence orifice at the gastroesophageal anastomosis. Considering of the cachexia state and the size of fistula, a new endoscopic clipping therapy, called mucosal incision-assisted closure with clips, was performed. The procedure as follows: First, used electrotome to puncture and destroy the epithelium of the fistula mouth. Then, mucosal incision was performed at the the proximal end of the fistula. Finally, one leg of the clip inserted into the dissected mucosa, and another leg was clamped to the fistula's opposite side to directly close the anastomotic defect. The whole process was finished in just a few minutes. After the operation, adequate nutrition and antibiotic support were given. The patient recovered rapidly and was discharged after 14 days without any complication. This successful case confirmed that mucosal incision-assisted closure with clips is a potentially viable and tight option for sealing esophageal leak, with excellent clamping and closing force.