Successful closure of an intrathoracic anastomotic major leak with the use of an Over-The-Scope-Clipping® system in a patient who had undergone esophagectomy

Abstract

We report a case of intrathoracic anastomotic major leakage after esophagectomy that was closed with the use of an Over-The-Scope-Clipping® System. The patient was a 77-year-old man. He underwent laparoscopic-assisted esophagectomy, gastric tube reconstruction using the posterior mediastinal route with intrathoracic anastomosis for esophageal cancer. A barium meal examination revealed no leakage and the patient started eating on postoperative day 4. A fever occurred and a large amount of meal was drained from the chest tube on postoperative day 7. A barium meal examination revealed major leakage of the esophagogastric anastomosis. We administered conservative treatment for 3 weeks, but the major anastomotic leak did not close. We completely closed the fistula of the anastomosis with the use of an OTSC® System on postoperative day 31. Meal intake was begun 7 days after closing the fistula with the OTSC® System, and the patient was discharged 42 days after closure. There have been few reports on the treatment of anastomotic leakage with the use of an OTSC® System; however, we speculate that this procedure is effective for the management of esophagogastric anastomotic major leakage.