A minimally invasive approach to esophagojejunostomy leakage: a retrospective cohort study of the efficacy of endoscopic Histoacryl injection compared with conventional treatments.

Purpose: Esophagojejunostomy leakage (EJL) continues to be a serious and potentially fatal complication following total gastrectomy for gastric cancer. This study aimed to evaluate the clinical outcomes of endoscopic Histoacryl (B. Braun) injection in comparison to alternative treatment strategies for EJL. Methods: Out of 885 patients who underwent total gastrectomy at a single institution between January 2003 and August 2023, 26 (2.9%) developed EJL. Patients were categorized into four groups according to the management received: conservative treatment (n = 5), endoscopic Histoacryl injection (n = 10), reoperation (n = 8), and combined therapy (n = 3). Outcomes assessed included postoperative hospital stay, duration to oral intake, treatment success rate, and mortality. Results: Of the 26 patients with EJL, 3 (11.5%) succumbed to sepsis: two in the reoperation group and 1 in the Histoacryl group. In the 23 successfully managed cases, the Histoacryl group achieved the shortest median postoperative hospital stay, the shortest time to resuming of oral intake, and a 90% success rate without any procedure-related complications. The reoperation group experienced increased morbidity and mortality. Stent migration was reported in one patient from the combined treatment group. Differences in recovery between the four groups reached statistical significance (P < 0.05). Conclusion: Endoscopic Histoacryl injection represents a safe, effective, and minimally invasive modality for managing EJL, providing improved recovery times and reduced complication rates. It is beneficial both as a primary intervention and as part of combination therapy.