Management of Tunnel Infection Following Upper Gastrointestinal Endoscopic Submucosal Tunneling Procedures

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OBJECTIVES: 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. METHOD: 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. RESULTS: 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). CONCLUSIONS: This comprehensive management approach demonstrated its effectiveness, and tunnel infection was successfully treated without requiring subsequent surgical interventions.

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