Endoscopic Management of Esophagogastric Anastomotic Leak

The incidence of esophageal cancer is increasing worldwide, with 450,000 new cases diagnosed each year. Almost 135,000 (30%) of these patients undergo surgical resection. Anastomotic leakage following esophagectomy is a significant complication that considerably increases postoperative mortality. Esophageal anastomotic leaks are reported between 3–25%, and the overall postoperative mortality rate is between 30 and 60% in the literature. Anastomotic leakages lead to a significant portion of postoperative mortality. Clinical presentations may vary from slightly symptomatic to fatal in certain circumstances. The location of the anastomosis (cervical or intrathoracic), the size of the anastomotic defect, and the spread of the contamination are all variables that may affect the severity of leakages. These factors also help make decisions about the most appropriate treatment method. Management of anastomotic leakages ranges from “conservative” methods such as antibiotics, gastric decompression, enteral or parenteral nutrition, and drainage procedures to endoscopic placement of self-expandable stents or vacuum-assisted closure devices, endoscopic clipping with the over-the-scope-clip, and surgery. However, the most effective treatment option for esophagogastric anastomotic leaks is debated, and there is no standardized treatment algorithm.