Endoscopic management of post-oesophagectomy anastomotic leaks using fully covered self-expandable metal stents with a novel clip-through-mesh fixation technique: A single-centre cohort study.

INTRODUCTION: Anastomotic leak after oesophagectomy remains a major cause of post-operative morbidity and mortality. Endoscopic placement of fully covered self-expandable metal stents (FC-SEMS) has emerged as a minimally invasive therapeutic option; however, real-world outcome data remain limited. We evaluated the outcomes of FC-SEMS placement for post-oesophagectomy leaks and described a novel clip-through-mesh fixation technique to reduce stent migration. PATIENTS AND METHODS: We conducted a retrospective cohort study of patients with post-oesophagectomy anastomotic leaks treated with FC-SEMS between December 2024 and December 2025 at a tertiary care center. Demographic, clinical, oncologic, surgical and procedural variables were collected. The outcomes assessed included leak characteristics, timing of intervention, stent dwell time, technical success, clinical healing, adverse events, mortality and functional recovery. A modified fixation method was used in all cases, whereby a through-the-scope clip was partially opened, passed through a single diamond-shaped stent mesh cell and deployed at a crossover point into the mucosa. RESULTS: Ten patients underwent FC-SEMS placement. Median time to leak detection was 12 days (range 7-20), and median maximum defect size was 3.25 cm. Multifocal leaks were present in 50% of patients. Surgical approaches included transhiatal (50%), transthoracic (30%) and subdiaphragmatic resections (20%). Technical success was achieved in all patients (100%), and complete clinical healing occurred in eight patients (80%). Two patients with large defects (>4 cm) and severe sepsis died despite technically successful stenting. No major stent-related adverse events were observed. No stent migration occurred during the follow-up. All surviving patients resumed oral intake after FC-SEMS placement, tolerated progressive diet advancement and remained symptom-free after stent removal during the follow-up. CONCLUSION: FC-SEMS placement is a feasible and effective first-line endoscopic therapy for post-esophagectomy anastomotic leaks. Early diagnosis, adequate drainage, antimicrobial therapy and nutritional support remain critical to success. The novel clip-through-mesh fixation technique was safe, reproducible and may help reduce stent migration.