Efficacy of endoscopic over-the-scope clip system for esophagojejunostomy leakage after total gastrectomy for gastric adenocarcinoma
QIU Aifeng
LI Lei
SHI Yuhua
YANG Yong
GE Guokan
Abstract：Objective To observe the efficacy of endoscopic over-the-scope clip(OTSC)system in the treatment of esophagojejunostomy leakage(EJL)after total gastrectomy for gastric adenocarcinoma,and to analyze the risk factors of the successful closure of OTSC technology.Methods Among 61 patients with EJL after total gastrectomy for gastric ade-nocarcinoma,34 received endoscopic OTSC clipping treatment.The occlusion of OTSC clips and the clinical efficacy were observed.The operation and postoperative conditions,follow-up and survival of patients were recorded.The influencing factors for the successful closure of OTSC technology were analyzed.Results Among the 34 patients,OTSC clips were successfully placed in 28 cases,with no bleeding,esophageal rupture or other endoscopic treatment-related complica-tions.There were 6 cases of clip failure,2 cases of patients with unreleased anastomotic clips were treated with self-ex-panding metal stent(cSEMS)(all fistulas were healed),and 4 patients with non-closed fistula were treated with cSEMS or surgery(1 case of fistula healed and 3 cases died).The clinical treatment was successful in 31 cases(91.2%),and no di-gestive tract fistula occurred again during the 6-month follow-up.There were 28 cases of tumor-free survival and good fistu-la healing,and 3 cases of non-tumor-related death.The results of univariate analysis showed that the time from the initial surgery to the diagnosis of fistula,the time from the diagnosis of fistula to OTSC clipping,and the longest diameter of the fistula opening were the influencing factors affecting the success closure of OTSC technology in EJL patients after total gas-trectomy for gastric adenocarcinoma(all P<0.05).The factor of P<0.20 was included in the multivariate analysis.The re-sults showed that the time from initial operation to confirmed fistula<3 days and the time from confirmed fistula diagnosis to OTSC clipping<7 days were the independent influencing factors for the successful closure of OTSC technology in EJL patients(all P<0.05).Conclusion For patients with EJL after total gastrectomy for gastric adenocarcinoma who have in-dications,early endoscopic OTSC clipping is safe and effective.
Keywords：gastric carcinomatotal gastrectomyesophagojejunostomy leakageover-the-scope clip system
Publication Date：2025-06-25
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 77-81 )