Defect Size-Based Comparative Analysis of Treatment Modalities for Esophagojejunal Anastomotic Leakage Following Gastrectomy
10.5230/jgc.2026.26.e20
- Author:
Ba Ool SEONG
;
Ji Yong AHN
;
Juno YOO
;
Chang Seok KO
;
Sa-Hong MIN
;
Chung Sik GONG
;
Beom Su KIM
;
Moon-Won YOO
;
Jeong Hwan YOOK
;
Hee Jin CHOI
;
In-Seob LEE
- Publication Type:Original Article
- From:Journal of Gastric Cancer
2026;26(2):295-306
- CountryRepublic of Korea
- Language:English
-
Abstract:
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.
