A case of anastomotic stenosis and fistula due to suture failure following total gastrectomy successfully managed using endoscopic therapy

In a 77-year-old male undergoing conservative treatment for suture failure following total gastrectomy, anastomotic stenosis and fistula expansion were observed, making it difficult to continue the treatment. Furthermore, postoperative cardiac hypofunction was diagnosed, making repeat surgery difficult ; therefore, the patient was referred to our department for endoscopic treatment on postoperative day 36. Upper gastrointestinal (GI) endoscopy revealed pinhole stenosis in the anastomotic region, and upper GI series indicated a 4-cm stenosis and contrast medium leakage from the fistula. After gradual dilation using an esophageal balloon, an Ultraflex esophageal covered stent was placed and the fistula was closed. Three days after stent placement, the patient was started on meals and discharged with no complications. Because stent blockages due to leftover food were observed twice, the stent was removed after 6 months using a two-channel endoscope for X-ray monitoring. Subsequently, the closure of the fistula was confirmed, and the patient is currently undergoing regular monitoring with no evidence of restenosis.