Thoracoscope-gastroscope dual-scope method in the treatment of thoracic esophageal foreign bodies：a clinical feasibility trial

Abstract:

Objective：To investigate the feasibility of a dual-scope method in the treatment of thoracic esophageal foreign bodies. Methods：73 patients were divided to a traditional surgery group（n=34） and a dual-scope surgery group（n=39）. In the traditional group，a 20cm skin incision was made above the 5th intercostal space，through which the researcher entered the chest，dissociated and cut open the esophagus，and then removed the esophageal foreign body. Four intercostal incisions were made in the dual-scope group. Light from the orally-inserted gastroscope was used to help the researcher dislocate and cut open the esophagus and then remove the esophageal foreign body. In the traditional group，patients with aorto-esophageal fistula were treated with thoracic endovascular aortic repair（TEVAR） first，and esophageal foreign body clearance，esophageal repair，and arterial hemostasis were performed afterwards. In the dual-scope group，TEVAR was performed simultaneously with esophageal foreign body clearance，while esophageal repair was performed later via video-assisted thoracoscopic surgery. Results：Accuracy rate of CT for diagnosis of thoracic esophageal foreign body and esophageal muscle injury was 100% and 90.41%，respectively. In traditional group operation time was 100（90，135） min，bleeding volume during operation was 200（150，300） mL. In dual-scope surgery group operation time was 90（90，110） min，bleeding volume during operation was 200（150，300） mL. There was no significant difference in operation time and bleeding volume during operation between the two groups. In the traditional group，11 cases had esophageal fistula and 6 cases had pneumonia. There were 1 case of esophageal fistula in the double-mirror group and 4 cases of pneumonia. There was a statistically significant difference in the incidence of esophageal fistula between the two groups；that of pneumonia was statistically insignificant. Aorto-esophageal fistula developed in 3 patients（1 patient in traditional group，2 patients in dual-scope group）. The patient in traditional group died after TEVAR，but the patients in the dual-scope group recovered and discharged successfully after TEVAR was performed si－multaneously with esophageal foreign body clearance. High risk factors of esophageal fistula in the thoracic esophageal foreign body patients include operation method，age，the course of disease as per results of logistic regression analysis；regression coefficients were -92.538，11.973 and 1.783，respectively. Conclusion：The dual-scope method can reduce the complications of thoracic esophageal foreign body surgery.