The three-tube method for esophageal perforation with mediastinal abscess caused by a foreign body: a retrospective cohort study
Year: 2026
Type: article
Abstract: Background: Foreign body-induced esophageal perforation can cause mediastinal abscess and life-threatening infection. Treatment is particularly challenging in patients with substantial physiological impairment who may poorly tolerate surgery or repeated endoscopic procedures. This study evaluated the clinical outcomes of fluoroscopy-guided tube-based management for this condition. Methods: This single-center retrospective cohort study included 72 patients with foreign body-induced esophageal perforation complicated by mediastinal abscess who underwent fluoroscopy-guided tube-based treatment between June 2015 and December 2025. The treatment framework combined nasojejunal feeding and gastrointestinal decompression with transnasal or percutaneous abscess drainage when indicated. Six patients with small fistulous openings, abscess cavities smaller than 2 cm, and favorable general conditions received a modified two-tube regimen without direct abscess drainage. Technical success, fistula healing, healing time, mortality, persistent fistula, and treatment-related complications were evaluated. Exploratory discrimination of clinical variables for delayed healing was assessed using receiver operating characteristic analysis with 1,000 bootstrap resamples. Results: The planned tube configuration was successfully placed in all 72 patients. Before intervention, 65 patients (90.3%) had an American Society of Anesthesiologists physical status of III or IV, and 18 required mechanical ventilation. During a median follow-up of 9 months, 58 patients (80.6%) achieved complete fistula healing and resumed oral intake, with a mean healing time of 98.16±43.56 days. Five patients died of severe infection, one died of massive hemorrhage, and eight developed persistent fistulas requiring long-term tube management. Abscess-drainage tube suction failure occurred in 41 patients and required fluoroscopic adjustment or replacement. Referral time (bootstrap-corrected area under the curve, 0.718; cutoff >5.50 days) and fistula size (corrected area under the curve, 0.705; cutoff >1.15 cm) showed exploratory discriminatory ability for delayed healing. Conclusions: Fluoroscopy-guided tube-based management was technically feasible and resulted in complete healing in 80.6% of this selected cohort, including patients requiring mechanical ventilation. However, prolonged healing, frequent catheter dysfunction, six deaths, and eight persistent fistulas demonstrate a substantial treatment burden. This approach may be considered within multidisciplinary care for carefully selected patients, but prospective comparative studies are required to establish its safety and effectiveness relative to surgical and endoscopic treatments.
Source: Journal of Thoracic Disease
Language: English
Topic: Esophageal and GI Pathology
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7222731248