Stepwise Transmural Migration of an Azygos Vein Polymer Locking Clip after Ivor Lewis Esophagectomy: A Case Report.

Abstract

Polymer locking clips are commonly used for azygos vein division during esophagectomy; however, clip-related complications involving the gastric conduit are rarely reported. We report the case of a 71-year-old man who developed dysphagia after Ivor Lewis esophagectomy for cT1N0 squamous cell carcinoma. During surgery, the azygos vein was divided using polymer locking clips, and an esophagogastric anastomosis was created with a 25-mm circular stapler. The early postoperative course was uneventful. At 2 months postoperatively, endoscopy revealed partial extrusion of a clip through the gastric conduit wall, without bleeding or fistula. Endoscopic removal was deferred because the clip remained embedded. At 5 months postoperatively, repeat endoscopy demonstrated complete intraluminal migration of the clip, which was removed endoscopically without immediate adverse events; balloon dilation was then performed for anastomotic narrowing. This case provides longitudinal endoscopic evidence that clip migration may occur as a stepwise transmural process. When partial extrusion is observed, delayed removal with interval monitoring may be safer than immediate traction.