The three-tube method via precise interventional placement for esophagojejunal anastomotic fistula after gastrectomy: A single center experience Running Title：Three-tube method for esophagojejunal anastomotic fistula

Abstract

Abstract Background Esophagojejunal anastomotic leakage is a serious complication after total gastrectomy. This study evaluated the safety and efficacy of transnasal placement of drainage tube, jejunal decompression tube, and jejunal nutrition tube under fluoroscopy for treatment of esophagojejunal anastomotic fistula after gastrectomy in gastric cancer patients.Methods Retrospective review of patients with esophagojejunal anastomotic fistula treated with transnasal placement of abscess drainage tube, decompression tube, and jejunal nutrition tube under fluoroscopy. Fistula healing time, patient survival, and Eastern Cooperative Oncology Group (ECOG) performance status before and after treatment were evaluated.Results Sixty-four patients were included in the study. Insertion of the transnasal abscess drainage tube, decompression tube, and jejunal nutrition tube was successful on the first attempt in all patients. Simple transnasal drainage was used in 35patients, simple percutaneous abscess drainage was used in 13 patients, and transnasal drainage plus percutaneous abscess drainage in 16patients. After placement of the tube, the mean volume of drainage was 180ml (10–850 mL); the amount steadily decreased from then on. The clinical treatment success rate is 84.3%(54/64). Median time to fistula healing was 58 days (7 days to 357 days).Conclusions Transnasal insertion of transnasal abscess drainage tube, jejunal decompression tube, and jejunal nutrition tube under fluoroscopy appears to be a simple, minimally invasive, effective, and safe method for treating esophagojejunal anastomotic fistula after gastrectomy.