Defect Size-Based Comparative Analysis of Treatment Modalities for Esophagojejunal Anastomotic Leakage Following Gastrectomy

Purpose: Esophagojejunal anastomotic leakage (EJAL) represents a severe postoperative complication following total or proximal gastrectomy.Treatment strategies include conservative management, endoscopic interventions, and surgery; however, comparative data remain limited.This study aimed to compare clinical outcomes of different strategies to identify the optimal approach based on anastomotic defect size.Materials and Methods: This retrospective study reviewed 100 patients diagnosed with EJAL between January 2015 and October 2024.Patients were categorized into four groups: conservative management, endoscopic vacuum-assisted closure (E-VAC), other endoscopic treatments, and surgery.The primary outcomes were leakage duration and length of hospital stay after EJAL diagnosis, whereas the secondary outcome was time to C-reactive protein normalization.Subgroup analyses were performed according to defect size.Results: Among the 100 patients, 76 were male and 24 were female, with a mean age of 65.7 years.Conservative treatment was the most common modality (53%), followed by other endoscopic treatments (19%), E-VAC (14%), and surgery (14%).In patients with a defect size <1 cm, conservative treatment was associated with significantly shorter leakage duration (P=0.035) and earlier resumption of diet (P=0.029)compared with endoscopic treatment.Among those with defects 2 cm, E-VAC demonstrated the most favorable median outcomes across all variables; however, statistical significance was not achieved because of the small sample size.Conclusions: Conservative treatment appears to be the most effective treatment strategy for EJAL with anastomotic defects <1 cm.For larger defects (2 cm), E-VAC may offer clinical benefit, although further studies are needed to confirm its efficacy.These findings highlight the importance of individualized treatment selection based on defect size.