Abstract:Background and Aims Esophagojejunal anastomotic leakage is one of the most severe complications after total gastrectomy and may lead to intra-abdominal or mediastinal infection with high mortality. Endoluminal vacuum-assisted closure (EVAC) has recently emerged as a minimally invasive treatment for gastrointestinal leaks; however, evidence regarding its application in esophagojejunal anastomotic leakage remains limited. This study aimed to evaluate the efficacy and safety of EVAC in the treatment of esophagojejunal anastomotic leakage.Methods Clinical data of 21 patients with esophagojejunal anastomotic leakage treated with EVAC at Jiangyin People's Hospital between January 2022 and July 2025 were retrospectively analyzed. All patients were diagnosed by endoscopy or imaging examinations and underwent placement of a self-made EVAC device under endoscopic guidance. Technical success rate, fistula closure rate, duration of EVAC therapy, healing time, length of hospital stay, changes in inflammatory markers, treatment-related complications, and long-term outcomes were evaluated.Results All 21 patients successfully underwent EVAC placement and negative-pressure therapy, with a technical success rate of 100%. Fistula closure was achieved in 18 patients, yielding a closure rate of 85.7%. The mean duration of EVAC therapy was (15.8±8.2) d, and the mean healing time was (19.1±9.4) d. The median postoperative hospital stay was 27 (25-49) d. White blood cell count and C-reactive protein levels were significantly reduced after treatment compared with pre-treatment values (both P<0.05). No severe treatment-related complications, including major gastrointestinal bleeding, stenosis, or foreign body retention, were observed. During a mean follow-up of (22.4±12.6) months, no recurrence of anastomotic leakage, gastrointestinal stenosis, or newly developed abscess was detected.Conclusion EVAC is an effective and safe minimally invasive treatment for esophagojejunal anastomotic leakage, with high technical success and fistula closure rates. It can effectively control infection and promote fistula healing, making it an important therapeutic option for this complication.