Study On The Related Factors And Treatment Of Gastric Esophageal Fistula After Submucosal Tunneling Endoscopic Resection

Objectives:To evaluate the efficacy and safety of gastric nutrition tube placement in the treatment of esophageal fistula after submucosal tunneling endoscopic resection(STER),and to explore the related factors and suggestive clinical manifestations of esophageal fistula after STER.Methods:From January 2013 to May 2022,patients with iatrogenic esophageal fistula who received gastric nutrition tube in our center after STER were collected.Enteral nutrition was supplemented by gastric nutrition tube,and the defect of tube wall was excluded for treatment,supplemented with acid inhibition,anti-inflammatory and other treatments.Meanwhile,clinical data(gender,age,length and diameter of impotence mouth,and clinical manifestations)of the patients were recorded,and symptoms(chest pain,vomiting,fever,etc.),repair of esophageal impotence,inflammatory response indicators(leukocytes,procalcitonin),nutritional indicators(albumin)and related complications of the patients before and after catheterization were analyzed.At the same time,transverse comparative study was conducted on the cases without esophageal fistula after STER operation.Results:88 patients were included in this study,including 22 patients with esophageal fistula after STER operation,with an average age of(50.91±12.45)years old,an average diameter of(1.90±0.64)cm,a wound healing rate of 50%within15 days and 100%within30 days,and a median catheter time(range)of 15.5 days(12-28 d),the incidence of infection was 77.3%,and the average time of antibiotic use was(6.3±1.5)d.All patients were indicated by reexamination that the esophageal mucosa repair was normal,and the clinical symptoms,inflammatory response indexes and nutritional indexes were improved compared with before.No serious complications occurred during or after extubation.According to the statistical analysis of the group with and without esophageal fistula after STER surgery,the length diameter and dissection time of the tumor in the two groups were correlated with the presence of esophageal fistula after STER surgery.The occurrence of chest and back pain,fever,swallowing pain and respiratory inhibition within 72 hours after the operation has suggestive significance for postoperative esophageal fistula.Conclusions:1.When STER was used to remove esophageal submucosal tumor(SMT),postoperative esophageal fistula was correlated with the presence of intraoperative mucosal ischemia.2.STER postoperative symptoms,such as chest and back pain,dysphagia,fever and so on,were not relieved for more than 72 hours,which could be used as indicative signs of esophageal fistula.3.Gastric nutrition tube placement in the treatment of esophageal fistula after the operation of STER has definite clinical significance.The curative effect is definite.