Endoscopic Ultrasound-guided Esophagojejunal Anastomosis for Delayed Reconstruction: A Case Series on the Novel Technique and our Experience

Esophagojejunal (EJ) anastomoses are integral to gastrointestinal reconstructive surgeries following procedures such as gastrectomy, particularly in cases of cancer or Roux-en-Y reconstruction. However, the traditional surgical EJ anastomosis approach can pose challenges with notable risks such as anastomotic leakage, stricture, or fistula formation. Endoscopic interventions have been employed for managing these adverse outcomes through stent placement, but a primarily endoscopic EJ anastomosis technique has not yet been described. This retrospective case series details five patients who underwent delayed endoscopic EJ anastomosis, with each patient under differing circumstances of instability necessitating this emergent alternative to standard surgical reconstruction. This approach involved the placement of a lumen-apposing metal stent between the esophagus and jejunum. Successful endoscopic EJ anastomosis was achieved in all cases, with hospital stays ranging from 6-13 days. Adverse events included stent migration, dysphagia, and stricture. Subsequent management strategies for these adverse events included stent removal and exchange, balloon dilation, triamcinolone injection, and appropriate follow-up. Follow-up evaluations revealed successful outcomes with no mortalities or anastomotic leaks. Primarily endoscopic EJ anastomosis for delayed reconstruction emerges as an advanced, minimally invasive alternative in complex patients deemed unsuitable for conventional surgical reconstruction secondary to instability or critical conditions. Within the literature, this is the first human case series description of an endoscopic EJ anastomosis with stent placement between the esophagus and jejunum. This novel technique offers the potential in improving patient outcomes which warrants further investigation to optimize these endoscopic techniques and assess its long-term efficacy across a larger patient cohort.