Endoscopic management of a gastroesophageal anastomotic leak and refractory stricture following robotic Ivor Lewis esophagectomy for esophageal adenocarcinoma

Abstract

Background: An anastomotic leak following esophagectomy represents a severe, life-threatening complication. Over the past decade, endoscopic vacuum therapy (EVT) has become the preferred minimally invasive treatment modality. However, even after successful EVT, benign strictures may develop, which in some cases can be refractory to endoscopic dilation. Case presentation: We present the case of a 75-year-old female patient who underwent robot-assisted Ivor Lewis esophagectomy for esophageal adenocarcinoma and subsequently developed an extensive anastomotic dehiscence with leakage of luminal contents into the pleural cavity. The complication was successfully managed with EVT. During follow-up, the patient developed a refractory anastomotic stricture unresponsive to repeated balloon dilations, which was effectively resolved by the placement of a lumen-apposing metal stent (LAMS), resulting in rapid reintroduction of oral intake and significant improvement in the quality of life. Conclusion: This case illustrates the successful use of modern endoscopic techniques, specifically EVT and LAMS stenting, in managing severe complications after esophagectomy. Close multidisciplinary collaboration was crucial. The endoscopic approach allowed for complete healing of the defect without the need for surgical reintervention providing an effective solution for the refractory stricture, with minimal burden on the patient.