Publication Name	World Journal of Gastrointestinal Surgery
Manuscript ID	122861
DOI	10.4240/wjgs.122861
Country	China

Category	Gastroenterology & Hepatology
Manuscript Type	Case Report
Article Title	Conservative management of a delayed esophagomediastinal fistula after endoscopic submucosal dissection: A case report
Manuscript Source	Unsolicited Manuscript
All Author List	Wen-Juan Ding, Han-Zhang Tang, Xiang-Rong Zhou, Wei-Hui Liu and Guang-Re Xu
Funding Agency and Grant Number
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
Key Words	Endoscopic submucosal dissection; Esophagomediastinal fistula; Delayed perforation; Conservative management; Fistula drainage; Case report
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.
Citation	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; In press DOI: https://doi.org/10.4240/wjgs.122861
PDF	122861-in-press.pdf

Received	2026-05-13 07:16
Peer-Review Started	2026-05-13 07:18
First Decision by Editorial Office Director
Return for Revision	2026-07-01 05:59
Revised	2026-07-15 07:44
Publication Fee Transferred	2026-07-26 12:22
Second Decision by Editor	2026-07-30 02:32
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-07-30 10:39
Articles in Press	2026-07-30 10:39
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1948-9366 (online)
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