Bridging the gap: intraoperative esophageal stent used as a scaffold for the treatment of complete postsurgical gastroesophageal anastomosis dehiscence

Q3 Medicine

VideoGIE Pub Date : 2026-08-01 Epub Date: 2026-03-27 DOI:10.1016/j.vgie.2026.03.004

Patricia Ziegler MD, Agnieszka Maniak MD, John Aversa MD, Christopher Chapman MD, Ajaypal Singh MD, Irving Waxman MD, Nicole Geissen MD, Neal Mehta MD

{"title":"Bridging the gap: intraoperative esophageal stent used as a scaffold for the treatment of complete postsurgical gastroesophageal anastomosis dehiscence","authors":"Patricia Ziegler MD, Agnieszka Maniak MD, John Aversa MD, Christopher Chapman MD, Ajaypal Singh MD, Irving Waxman MD, Nicole Geissen MD, Neal Mehta MD","doi":"10.1016/j.vgie.2026.03.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and Aims</h3><div>Esophagogastric (EG) anastomotic leaks are serious adverse events after esophagectomy. Endoscopic stent placement has become an effective, minimally invasive option that promotes healing. While esophageal stents maintain luminal continuity, technical success rates are as high as 90.9%. A 62-year-old man with esophageal adenocarcinoma presented 12 days after McKeown esophagectomy with dyspnea and empyema. Imaging and chest tube output suggested an anastomotic leak. The aim of this study was to display the utility of esophageal stent placement even in cases of complete EG dehiscence.</div></div><div><h3>Methods</h3><div>Intraoperative exploration revealed complete EG dehiscence. Using robotic surgical guidance, we advanced a gastroscope through the mediastinum into the stomach, and a guidewire was passed to facilitate placement of a 20- × 100-mm fully covered self-expandable metal stent. Given the emergent intraoperative nature of the case and the use of a travel cart, endoscopic images are limited or mostly unavailable.</div></div><div><h3>Results</h3><div>The stent provided a scaffold for reapproximation and repair with interrupted sutures and biological mesh. The patient recovered uneventfully, resumed tube feeds, and advanced to oral intake within 2 months. The stent was removed 4 months after placement without stricture or need for dilation.</div></div><div><h3>Conclusions</h3><div>Complete EG dehiscence typically necessitates high-risk surgical repair. In this case, endoscopic stent placement enabled luminal restoration and guided repair, demonstrating a novel multidisciplinary approach to a complex adverse event. Intraoperative endoscopic stent placement can successfully manage complete anastomotic dehiscence, emphasizing the value of coordinated surgical/endoscopic strategies to preserve function.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"11 8","pages":"Pages 321-324"},"PeriodicalIF":0.0000,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"VideoGIE","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2468448126000615","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/3/27 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Background and Aims

Esophagogastric (EG) anastomotic leaks are serious adverse events after esophagectomy. Endoscopic stent placement has become an effective, minimally invasive option that promotes healing. While esophageal stents maintain luminal continuity, technical success rates are as high as 90.9%. A 62-year-old man with esophageal adenocarcinoma presented 12 days after McKeown esophagectomy with dyspnea and empyema. Imaging and chest tube output suggested an anastomotic leak. The aim of this study was to display the utility of esophageal stent placement even in cases of complete EG dehiscence.

Methods

Intraoperative exploration revealed complete EG dehiscence. Using robotic surgical guidance, we advanced a gastroscope through the mediastinum into the stomach, and a guidewire was passed to facilitate placement of a 20- × 100-mm fully covered self-expandable metal stent. Given the emergent intraoperative nature of the case and the use of a travel cart, endoscopic images are limited or mostly unavailable.

Results

The stent provided a scaffold for reapproximation and repair with interrupted sutures and biological mesh. The patient recovered uneventfully, resumed tube feeds, and advanced to oral intake within 2 months. The stent was removed 4 months after placement without stricture or need for dilation.

Conclusions

Complete EG dehiscence typically necessitates high-risk surgical repair. In this case, endoscopic stent placement enabled luminal restoration and guided repair, demonstrating a novel multidisciplinary approach to a complex adverse event. Intraoperative endoscopic stent placement can successfully manage complete anastomotic dehiscence, emphasizing the value of coordinated surgical/endoscopic strategies to preserve function.

查看原文本刊更多论文

弥合差距：术中食管支架作为支架治疗完全性术后胃食管吻合口破裂

背景与目的食管胃（EG）吻合口漏是食管切除术后的严重不良事件。内窥镜支架放置已经成为一种有效的、微创的、促进愈合的选择。食管支架维持腔内连续性，技术成功率高达90.9%。一名62岁男性食管腺癌患者在McKeown食管切除术后12天出现呼吸困难和脓胸。影像学和胸管输出提示吻合口漏。本研究的目的是显示食管支架置入术的效用，即使是在EG完全破裂的情况下。方法术中探查显示EG完全破裂。在机器人手术指导下，我们将胃镜通过纵隔进入胃，并通过导丝以方便放置一个20 × 100毫米的全覆盖自膨胀金属支架。鉴于该病例的急诊性质和使用旅行车，内窥镜图像有限或大部分无法获得。结果该支架为断线修复和生物补片修复提供了支架。患者恢复平稳，恢复管饲，并在2个月内转入口服。支架放置4个月后取出，无狭窄或需要扩张。结论完全性EG开裂通常需要高危手术修复。在这种情况下，内镜支架置入使腔内修复和引导修复，展示了一种新的多学科方法来处理复杂的不良事件。术中内镜支架置入可以成功地处理完全吻合口裂开，强调手术/内镜协调策略对保持功能的价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.