Seal and heal: endoscopic stenting for anastomotic leakage after gastrectomy

Aims: Gastric cancer is the fifth most common cancer worldwide. Anastomotic leaks are one of the most important causes of early postoperative mortality and morbidity. We aimed to investigate results of endoscopic stenting after anastomostic leakage. Methods: The study retrospectively analyzed data from patients who had gastric tumor surgeries at the Surgical Oncology Clinic of Ankara Etlik City Hospital between November 2022 and April 2024. Clinical presentation leading to leak suspicion, and endoscopy timing, post-endoscopic stent placement, the study recorded several outcomes such as reduction in fistula output, resumption of oral intake, normalization of biochemical parameters, drain removal, and discharge timing. It also tracked readmission details, the total number of endoscopic procedures, and stent removal times. Results: Anastomotic leaks developed in 8 patients (12.9%) and all of them had stents placed. Among the patients who received stents, 7 patients (87.5%) were male and one patient (12.5%) was female. The first symptoms of anastomotic leaks developed on mean on the 3.7th day, and endoscopic stent placement was performed on mean 28.25 hours after the initial symptoms appeared. Follow-up of patients with stents revealed that 37.5% (n: 3) had stent malposition. One patient (12.5%) required repeated balloon dilation due to stent migration and anastomotic stricture. It was observed that patients had recurrent visits and required additional endoscopic interventions after endoscopic stenting Conclusion: Endoscopic stenting is a significant method in managing anastomotic leaks after gastrectomies performed for gastric cancer, with low mortality and morbidity rates. Clinical problems such as stricture and stent migration, which can occur after endoscopic stent placement for anastomotic leaks, can be overcome through repeated interventions performed with patience and care by experienced centers.