Kim HS, Kim Y, Han JH. Endoscopic salvage treatment of histoacryl after stent application on the anastomotic leak after gastrectomy: A case report. World J Clin Cases 2021; 9(1): 262-266 [PMID: 33511194 DOI: 10.12998/wjcc.v9.i1.262]
Corresponding Author of This Article
Joung-Ho Han, MD, PhD, Professor, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Chungdae-ro 1, Seowon-gu, Cheongju-si 28644, South Korea. joungho@cbnu.ac.kr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
World J Clin Cases. Jan 6, 2021; 9(1): 262-266 Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.262
Endoscopic salvage treatment of histoacryl after stent application on the anastomotic leak after gastrectomy: A case report
Hee-Sung Kim, Yook Kim, Joung-Ho Han
Hee-Sung Kim, Joung-Ho Han, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si 28644, South Korea
Yook Kim, Department of Radiology, Chungbuk National University Hospital, Cheongju-si 28644, South Korea
Author contributions: Kim HS and Kim Y contributed equally to this work; Kim HS and Kim Y collected the patient’s clinical data and wrote the paper; Han JH designed the report; all authors read and approved the final version of the manuscript.
Supported by2020 Research Fund of the Chungbuk National University.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Joung-Ho Han, MD, PhD, Professor, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Chungdae-ro 1, Seowon-gu, Cheongju-si 28644, South Korea. joungho@cbnu.ac.kr
Received: September 21, 2020 Peer-review started: September 11, 2020 First decision: September 29, 2020 Revised: October 9, 2020 Accepted: November 21, 2020 Article in press: November 21, 2020 Published online: January 6, 2021 Processing time: 102 Days and 8.6 Hours
Abstract
BACKGROUND
Endoscopic approach could effectively manage postoperative anastomotic leakage. Various endoscopic methods have been developed for the treatment of anastomotic leakage.
CASE SUMMARY
A 53-year-old woman developed anastomotic leak after laparoscopic proximal gastrectomy. Endoscopic clip closure failed due to strong wall tension; therefore, a fully covered self-expandable esophageal metal stent (fc-SEMS) was placed to cover the leak after it was filled with a mixture of fibrin glue and histoacryl. However, fluoroscopy with gastrograffin showed dye leaking out of the fc-SEMS. Using the previous fluoroscopic image for guidance, a catheter was inserted at the leakage site. The radiocontrast dye was injected and was seen spreading along the sinus tract. Thereafter, histoacryl was injected. Seven days after the last procedure, upper gastrointestinal contrast studies showed no leaks. The patient was subsequently discharged 9 d after histoacryl injection without any complications.
CONCLUSION
To seal an anastomosis leak after stent application, salvage technique using histoacryl injection at the leakage site with fluoroscopy guidance could be considered cautiously.
Core Tip: Endoscopic treatment including stent deployment, clipping or fibrin glue is considered as a safe and effective treatment options for anastomotic leakage after gastrectomy. We successfully treated esophago-gastric anastomotic leakage with endoscopic salvage treatment of add-on histoacryl after fully covered self-expandable esophageal metal stent (fc-SEMS). Histoacryl injection after fc-SEMS application on the anastomotic leak should be considered as treatment option.
