Reducing anastomotic complications with endoscopy in laparoscopic total gastrectomy

Sep 28, 2026

BACKGROUND: Early postoperative anastomosis-related complications often reflect technical defects during the anastomotic step, yet limited evidence addresses intraoperative issues in esophagojejunostomy performed with a circular stapler. AIM: Evaluate whether endoscopic examination can reduce early postoperative anastomosis-related complications. METHODS: Retrospective analysis of 160 gastric cancer patients undergoing laparoscopic total gastrectomy with circular-stapler esophagojejunostomy (Jan 2020-Dec 2023), comparing intraoperative endoscopic examination versus no intraoperative endoscopy. RESULTS: Anastomotic defects were detected in 8.8% with intraoperative endoscopy and none developed postoperative complications (0%) versus 7.5% in the non-IEE group. CONCLUSION: Routine intraoperative endoscopic examination enables immediate detection and repair, significantly reducing early anastomotic complications.

LanguageEnglish

CategoryHealthcare

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Pages10

Reading Time25 min

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| W | J | G | S | World Journal of
Gastrointestinal Surgery | | --- | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Gastrointest Surg 2025 December 27; 17(12): 114079 DOI: 10.4240/wjgs.v17.i12.114079 ISSN 1948-9366 (online) ORIGINAL ARTICLE Retrospective Study Reducing anastomotic complications with endoscopy in laparoscopic total gastrectomy Lei Gong, Jing Yu, Zhen-Bing Lv, Xiang-Zhi Qin, Min Li, Wei Guo, Bin Huang, Yun-Hong Tian Specialty type: Gastroenterology and hepatology Provenance and peer review: Unsolicited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade B Novelty: Grade B Creativity or Innovation: Grade C Scientific Significance: Grade C P-Reviewer: Gong Y, Assistant Professor, China Received: September 11, 2025 Revised: September 23, 2025 Accepted: October 27, 2025 Published online: December 27, 2025 Processing time: 105 Days and 16.7 Hours Lei Gong, Jing Yu, Zhen-Bing Lv, Xiang-Zhi Qin, Min Li, Wei Guo, Bin Huang, Yun-Hong Tian, Department of General Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China Co-first authors: Lei Gong and Jing Yu. Corresponding author: Yun-Hong Tian, MD, PhD, Chief Physician, Professor, Department of General Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, No. 97 Renmin South Road, Shunqing District, Nanchong 637000, Sichuan Province, [China.](China. drtianyunhong@126.com)[ drtianyunhong@126.com](China. drtianyunhong@126.com) Abstract BACKGROUND Early postoperative anastomosis-related complications are frequently associated with technical defects during the anastomotic procedure. Few studies focused on intraoperative anastomotic complications in esophagojejunostomy with circular stapler. AIM To explore whether endoscopic examination could reduce the occurrence of early postoperative anastomotic complications. METHODS Clinical data from 160 patients with gastric cancer who underwent laparoscopic total gastrectomy with esophagojejunostomy using a circular stapler at Nanchong Central Hospital from January 2020 to December 2023 were retrospectively analyzed. Based on whether intraoperative endoscopic examination (IEE) was performed, patients were divided into the IEE group and the non-IEE (NIEE) group. RESULTS All patients successfully underwent laparoscopic total gastrectomy with esophagojejunostomy using a circular stapler. In the IEE group, 7 (8.8%) patients were found to have anastomotic defects: 3 (3.8%) air leaks, 2 (2.5%) bleeding, 1 (1.3%) stricture and 1 (1.3%) full-thickness tearing. Three patients with anastomotic discontinuities were subsequently treated with additional suturing. One anastomotic bleeding was managed with laparoscopic suturing, and another was treated with endoscopic clips. One patient had anastomotic stricture, which was corrected intraoperatively. One patient experienced full-thickness tearing caused by the WJGS [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 27, 2025 Volume 17 Issue 12 Gong L et al. Endoscopic assessment for anastomotic complications in LTG circular stapler, necessitating a redo anastomosis. These anastomotic defects were repaired intraoperatively, and no postoperative anastomotic complications occurred. 6 (7.5%) patients with postoperative anastomotic complications were observed in the NIEE group. The NIEE group had a significantly higher incidence of postoperative anastomosis-related complications compared to the IEE group (7.5% vs 0%; P = 0.029) . CONCLUSION Routine IEE significantly reduces early anastomotic complications by enabling immediate detection and repair of technical defects in esophagojejunostomy with circular stapler. Key Words: Gastric cancer; Lap

FAQs

What was the primary purpose of this retrospective study?

To determine whether intraoperative endoscopic examination can reduce early postoperative anastomosis-related complications in esophagojejunostomy using a circular stapler.

How were patients grouped in the study?

Patients who had intraoperative endoscopic examination were placed in the IEE group, while patients without intraoperative endoscopy were placed in the non-IEE (NIEE) group.

What were the key outcome differences between groups?

The IEE group had no postoperative anastomotic complications (0%), while the NIEE group showed a significantly higher incidence of postoperative anastomosis-related complications (7.5%, P=0.029).

How did intraoperative endoscopy affect management of detected defects?

Detected anastomotic defects were repaired immediately intraoperatively, including additional suturing, laparoscopic suturing for bleeding, endoscopic clips for bleeding, and intraoperative correction of stricture; one case required redo anastomosis after full-thickness tearing.

Sep 28, 2026

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