Innovative Endoscopic Treatment of Dual Gastric Perforations Using Argon Plasma Coagulation and Hybrid Closure Techniques

Anastomotic leaks and conduit perforations are serious complications following Ivor Lewis esophagectomy. A 65-year-old man with tobacco use, obesity, obstructive sleep apnea, hypertension, and gastroesophageal junction adenocarcinoma underwent Ivor Lewis esophagectomy complicated by an anastomotic leak. Endoscopy confirmed dehiscence, successfully treated with a 20 mm AXIOS stent. A second full-thickness perforation from a chest tube traversing the gastric conduit staple line was also identified. Multiple endoscopic attempts, including argon plasma coagulation, OVESCO clipping, and OverStitch suturing, failed due to poor tissue apposition. A novel approach using Surgicel packing with fibrin sealant and Dermabond achieved closure. Chest tubes were removed, and the patient recovered fully, highlighting an effective salvage strategy in complex postoperative complications.