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Large anastomotic leak: endoscopic treatment using combined fibrin glue and polyglycolic acid (PGA) sheets
  1. Soo In Choi and
  2. Ji Young Park
  1. Internal Medicine, Inje University Sanggye Paik Hospital, Nowon-gu, Seoul, Korea (the Republic of)
  1. Correspondence to Professor Ji Young Park; human{at}


Anastomotic leak after gastrectomy is a major complication and various endoscopic methods have been suggested. However, the treatment of large-sized leaks remains a challenge. Here, we present a case of a large anastomotic leak successfully treated endoscopically using a combination of fibrin glue and polyglycolic acid (PGA) sheets. A 68-year-old man who underwent laparoscopic total gastrectomy and oesophagojejunal anastomosis presented with abdominal pain and fever. In the endoscopic examination, two fistulas were observed at the anastomosis site. One was small (0.6 cm) while the other measured 2.5 cm. For the large leak, endoscopic treatment using endoclip and detachable snare was attempted, but failed. Subsequently, fibrin glue was injected into the large fistula through an endoscope. After 28 days, the size of the fistula was reduced and PGA sheets were inserted into the remaining fistula. After about 4 weeks, leaks were observed to be completely healed.

  • endoscopy
  • gastrointestinal surgery

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  • Contributors Supervised by JYP. The patient was under the care of JYP. Report was written by SIC.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.