Work

Intraoperative perforating vessel injury as a key risk factor for esophageal fistula formation after endoscopic resection of giant esophageal submucosal tumors

Year: 2025

Type: article

Abstract: BACKGROUND AND AIM: Endoscopic resection (ER) has been successfully used to remove giant esophageal submucosal tumors (SMTs). However, though rare, esophageal fistula can also develop after endoscopic resection. The aim of this study was to evaluate risk factors for fistula formation after ER of giant esophageal SMTs. METHODS: This retrospective study enrolled patients with huge esophageal SMTs who underwent ER. We collected patient demographics, lesion-related factors, and procedural outcomes data and explored the correlation between esophageal fistula formation and damage to perforating vessels. RESULTS: Of 174 patients, 17 (9.8%) had esophageal fistula. The multivariate analysis demonstrated that perforating vessel damage and full-thickness muscular injury were significant risk factors for esophageal fistula. Then, we used a scoring system to predict esophageal fistula and categorized patients into low-risk (0-2) and high-risk (3-6) groups. Patients with high scores were more likely to suffer esophageal fistula. Our score model presented excellent discriminatory power in the internal validation (AUC: 0.932; 95% CI: 0.797-1.000) and goodness-of-fit in the Hosmer-Lemeshow test (p = 0.748). CONCLUSIONS: Fistula formation after ER of giant esophageal SMTs is associated with damage to perforating vessels.

Source: International Journal of Surgery

DOI: 10.1097/js9.0000000000003716