The stability of esophagojejunal anastomosis after total gastrectomy is one of the most complex issues for gastrointestinal surgeons. Because esophagojejunal leakage (EJL) can result in mortality due to pleural and peritoneal abscesses, many centers have their own routine screening protocols for the early detection of EJLs. The treatment of EJL varies from conservative care to reoperation. A few case reports have recently tried endoscopic Histoacryl injection (EHI) to the EJL site during several endoscopic interventions [1,2]. A recently published article in the Journal of Minimally Invasive Surgery discussed the impact of Histoacryl injection on esophagojejunal anastomosis leakage and reported a success rate of seven out of eight cases (87.5%) without procedure-related complications [3].

Histoacryl, monomeric n-butyl-2-cyanoacrylate, has been widely accepted for various uses [4–6]. Since Histoacryl has already been adopted for sclerotherapy to treat gastrointestinal ulcers or variceal bleeding by sealing off the site, the safety concern for gastrointestinal tract applications is minimal [5].

EHI may also be successful with another type of anastomosis. Kim et al. [3] published a case report in which EHI was used as a salvage treatment after an endoscopic, fully-covered, self-expandable metallic stent (fc-SEMS) insertion failed to treat esophagogastric anastomosis leakage after proximal gastrectomy. The patient in this case suffered from fever and abdominal pain on the fourth postoperative day after proximal gastrectomy with esophagogastric anastomosis. Esophagogastric anastomosis leakage was found during upper gastrointestinal series (UGIS) and endoscopic fc-SEMS insertion was carried out. However, further UGIS showed persistent anastomosis leakage. Histoacryl was injected between the stent and the leakage site endoscopically and further UGIS showed no leakage after 7 days of injection [1].

Other than anastomosis leakage, EHI may also be helpful for the treatment of fistulous complications. Chen et al. [2] published a case report on the successful treatment of esophagopleural fistula after total gastrectomy. In this case, a patient who underwent total gastrectomy for advanced gastric cancer suffered from postprandial pain and fever. The authors found an esophagopleural fistula 1.5 cm above the anastomosis. The authors tried initial treatments with chest tube drainage and video-assisted thoracoscopic decortications but failed to close the fistula. The fistula healed 7 days after 2 mL of Histoacryl injection was administered onto the fistula opening.

EHI is a relatively simple and technically feasible procedure. Therefore, many surgeons will take advantage of this safe and feasible procedure to treat anastomosis leakage complications. We are expecting more results in the near future to provide directions for further comparative studies between other interventional treatment options.

Conflict of interest

The author has no conflicts of interest to declare.

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