Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2015; 21(28): 8723-8729
Published online Jul 28, 2015. doi: 10.3748/wjg.v21.i28.8723
Conservative reconstruction using stents as salvage therapy for disruption of esophago-gastric anastomosis
Taro Oshikiri, Yoshinobu Yamamoto, Ikuya Miki, Masahiro Tsuda, Tetsu Nakamura, Yasuhiro Fujino, Masahiro Tominaga, Yoshihiro Kakeji
Taro Oshikiri, Yasuhiro Fujino, Masahiro Tominaga, Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan
Yoshinobu Yamamoto, Ikuya Miki, Masahiro Tsuda, Department of Gastroenterological Oncology, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan
Tetsu Nakamura, Yoshihiro Kakeji, Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo 650-0017, Japan
Author contributions: Oshikiri T designed the research; Oshikiri T, Yamamoto Y, Miki I, Tsuda M, Nakamura T and Fujino Y performed the research; and Oshikiri T, Tominaga M and Kakeji Y wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Hyogo Cancer Center Institutional Review Board.
Informed consent statement: All of the study participants or their legal guardians provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there are no financial or commercial conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Taro Oshikiri, MD, Department of Gastroenterological Surgery, Hyogo Cancer Center, 13-70 kitaoji-cho, Akashi, Hyogo 673-8558, Japan. oshikiri@med.kobe-u.ac.jp
Telephone: +81-78-9291151 Fax: +81-78-9292380
Received: March 12, 2015
Peer-review started: March 13, 2015
First decision: April 13, 2015
Revised: May 2, 2015
Accepted: May 27, 2015
Article in press: May 27, 2015
Published online: July 28, 2015
Processing time: 140 Days and 1.1 Hours
Abstract

Esophagectomy with extended lymphadenectomy and gastric conduit reconstruction is a radical procedure for the treatment of esophageal cancer that is associated with a high morbidity rate. Gastric conduit necrosis is a fatal complication that occurs in 2% of patients. Conventionally, two-stage salvage surgery consisting of removal of the necrotic gastric conduit followed by reconstruction has been performed; however, this procedure has a high morbidity rate. We describe a 61-year-old man who underwent minimally invasive esophagectomy complicated by slowly progressive gastric conduit necrosis associated with complete neck drainage and a stable overall condition. There was a 2 cm gap in the anastomosis. Because there was no evidence of residual gastric conduit necrosis, a removable, covered self-expanding metal stent (SEMS) was inserted to bridge the anastomosis. The stent was fixed to the patient’s ear with silk thread through the lasso on its proximal end to prevent migration. Eight weeks after insertion, the stent was removed easily without any associated complications. The anastomotic defect was completely bridged with granulation tissue, showing progressive epithelialization without leakage or stenosis. The patient was discharged home in good general health. This is the first report of the successful conservative management of esophago-gastric conduit anastomosis disruption with SEMS placement.

Keywords: Esophagectomy; Gastric conduit necrosis; Disruption of anastomosis; Self-expanding metal stent; Hanarostent; Conservative management

Core tip: Gastric conduit necrosis is a fatal complication after esophagectomy. Conventionally, two-stage salvage surgery consisting of removal of the necrotic gastric conduit followed by reconstruction has been performed, but it has a high morbidity rate. On the other hand, a covered self-expanding metal stent (SEMS) has been reported to be effective for the treatment of anastomotic leakage. This is the first report of the successful conservative management of gastric conduit necrosis with SEMS placement. This case highlights the diagnosis and evaluation of the state of esophago-gastric conduit anastomosis disruption and demonstrates that a conservative approach with no surgery could result in a successful outcome.