Luo Shao-Bin, Wang Li, Liu Zu-Qiang, Zhang Yi-Qun, Chen Wei-Feng, Ma Li-Li, Hu Jian-Wei, Cai Ming-Yan, Li Quan-Lin, Zhou Ping-Hong
Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China.
J Gastroenterol Hepatol. 2025 Aug;40(8):2007-2017. doi: 10.1111/jgh.17004. Epub 2025 Jun 12.
Tunnel infection is a rare but major adverse event after endoscopic submucosal tunneling procedures (ESTPs), which is scarcely reported. This study aims to offer a comprehensive analysis of the evaluation and management of tunnel infection following ESTP.
From August 2010 to December 2023, we retrospectively analyzed 4398 patients with achalasia receiving peroral endoscopic myotomy (POEM) and 2214 patients with upper gastrointestinal tumors receiving submucosal tunneling endoscopic resection (STER). Patients diagnosed with postoperative tunnel infection were included, and the various treatments utilized for managing these infections and outcomes were documented.
There were 17 cases of ESTP tunnel infection in patients (10 men; median age 47 years). Among the patients, nine underwent POEM and eight underwent STER. With similar baseline characteristics between two groups after PSM, the tunnel infection group of POEM showed higher rate of mucosal injury (44.4% vs. 11.1%, p = 0.029) and the tunnel infection group of STER showed larger tumor size (3.3 cm vs. 2.3 cm, p = 0.036). The treatment of tunnel infection included insertion of a gastric tube into the tunnel for drainage (nine cases), tunnel mucosal incision (eight cases), and tunnel flushing (seven cases), and no patient required surgical intervention. All patients received broad-spectrum antibiotics to control the infection. A total of three individuals required thoracic drainage for reactive pleural effusion. The median post-infection hospital stay was 18 days (range 5-38).
This comprehensive management approach demonstrated its effectiveness, and tunnel infection was successfully treated without requiring subsequent surgical interventions.
隧道感染是内镜黏膜下隧道技术（ESTPs）后一种罕见但严重的不良事件，鲜有报道。本研究旨在对ESTP术后隧道感染的评估与处理进行全面分析。
回顾性分析2010年8月至2023年12月期间4398例接受经口内镜下肌切开术（POEM）的贲门失弛缓症患者和2214例接受黏膜下隧道内镜切除术（STER）的上消化道肿瘤患者。纳入诊断为术后隧道感染的患者，记录处理这些感染所采用的各种治疗方法及结果。
患者中有17例发生ESTP隧道感染（男性10例；中位年龄47岁）。其中，9例接受POEM，8例接受STER。倾向评分匹配后两组基线特征相似，POEM隧道感染组黏膜损伤发生率更高（44.4% 对11.1%，p = 0.029），STER隧道感染组肿瘤尺寸更大（3.3 cm对2.3 cm，p = 0.036）。隧道感染的治疗包括在隧道内插入胃管引流（9例）、隧道黏膜切开（8例）和隧道冲洗（7例），无一例患者需要手术干预。所有患者均接受广谱抗生素以控制感染。共有3例患者因反应性胸腔积液需要胸腔引流。感染后中位住院时间为18天（范围5 - 38天）。
这种综合管理方法显示出有效性，隧道感染得以成功治疗，无需后续手术干预。
