Ding WJ, Tang HZ, Zhou XR, Liu WH, Xu GR. Conservative management of a delayed esophagomediastinal fistula after endoscopic submucosal dissection: A case report. World J Gastrointest Surg 2026; 18(10): 122861 [DOI: 10.4240/wjgs.122861]
Corresponding Author of This Article
Guang-Re Xu, MD, Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32 First Ring Road, Chengdu 610072, Sichuan Province, China. xgre@sina.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
case-report
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Ding WJ, Tang HZ, Zhou XR, Liu WH, Xu GR. Conservative management of a delayed esophagomediastinal fistula after endoscopic submucosal dissection: A case report. World J Gastrointest Surg 2026; 18(10): 122861 [DOI: 10.4240/wjgs.122861]
Wen-Juan Ding, Xiang-Rong Zhou, Department of Gastroenterology, Jianyang People’s Hospital, Chengdu 641400, Sichuan Province, China
Han-Zhang Tang, Department of Internal Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan Province, China
Wei-Hui Liu, Guang-Re Xu, Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan Province, China
Co-first authors: Wen-Juan Ding and Han-Zhang Tang.
Author contributions: Ding WJ and Tang HZ were responsible for drafting of manuscript and critical revision as co-first authors; Ding WJ, Zhou XR, and Liu WH were responsible for acquisition of data (laboratory or clinical), data analysis and interpretation; Ding WJ and Xu GR were responsible for conception and design of study; Xu GR was responsible for approval of final version of manuscript; all authors read and approved the submitted manuscript.
AI contribution statement: AI tools were not listed as authors and were not used to generate original research data, conduct independent analyses, interpret results autonomously, or draw scientific conclusions. All scientific reasoning, methodological decisions, data interpretation, and conclusions were developed and validated exclusively by the author.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Guang-Re Xu, MD, Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32 First Ring Road, Chengdu 610072, Sichuan Province, China. xgre@sina.com
Received: May 13, 2026 Revised: July 15, 2026 Accepted: July 30, 2026 Published online: October 27, 2026 Processing time: 166 Days and 1.2 Hours
Abstract
BACKGROUND
In this report, we summarize our experience with conservative management in a rare case of delayed perforation with mediastinal fistula formation following endoscopic submucosal dissection (ESD) for long-segment circumferential early esophageal cancer.
CASE SUMMARY
The patient had developed a delayed perforation with formation of mediastinal fistula following ESD. A multidisciplinary conservative regimen was implemented, consisting of targeted long-term antimicrobial therapy, repeated low-pressure sinus tract irrigation, continuous sinus and thoracic closed drainage, and early enteral nutrition support guided by nutrition specialists. Meticulous nursing care was continued for more than 50 days, following which the fistula healed and the patient was discharged successfully.
CONCLUSION
Systematic multidisciplinary conservative management combining infection control, adequate fistula drainage, and nutritional support can achieve complete healing of delayed ESD-related esophagomediastinal fistula in selected stable patients.
Core Tip: We report a rare case of severe, ultra-late esophagomediastinal fistula occurring on postoperative day 23 following circumferential endoscopic submucosal dissection. Instead of emergency thoracic surgery, we adopted a multidisciplinary conservative strategy with three core pillars: (1) Culture-guided, long-term antimicrobial infection control; (2) Prolonged low-pressure sinus tract irrigation and closed drainage; and (3) Early jejunal enteral nutrition. Joint participation of gastroenterology, infectious disease, thoracic surgery, radiology and nutrition teams optimized clinical decision making. This multidisciplinary approach was useful in achieving complete fistula healing, demonstrating that systematic non-operative management is a viable and effective option for selected patients, precluding the risks of major surgery. Clinicians should maintain high vigilance for ultra-late delayed perforation after full-circumferential esophageal endoscopic submucosal dissection, with serial postoperative monitoring to exclude sepsis and occult mediastinal infection.
