The three-tube method under fluoroscopy guidance for post-gastrectomy gastric fistula

Background: Gastric fistula represents a rare but life-threatening complication of gastrectomy. The purpose of this study was to explore the safety and effectiveness of fluoroscopy-guided three-tube insertion for the management of post-gastrectomy gastric fistulas. Methods: Patients with post-gastrectomy gastric fistulas treated with the three-tube method between March 2013 and October 2024 were retrospectively analyzed. The procedure consisted of placement of a nasojejunal feeding tube, a nasogastric decompression tube, and a transnasal/percutaneous drainage tube, under local anesthesia and conscious sedation. Regular upper gastrointestinal (GI) contrast imaging was performed, and all tubes were removed upon complete healing of fistula and abscess. Results: A total of 40 patients were included in our study. Fluoroscopy-guided three-tube insertion was successful in all patients (technical success rate: 100%). Accurate and effective tube placement were confirmed on repeat imaging. Clinical improvement was observed in terms of symptom resolution, normalization of laboratory markers, as well as the healing of fistula and abscess cavity. The median fistula healing time was 3.3 [interquartile range (IQR), 2.3, 9.0] months. No clinical deterioration or procedure-related complications were reported. Oral diet was resumed in 80% patients. At a follow-up of 3-60 months, no fistula or abscess recurrence was observed. Conclusions: Fluoroscopy-guided three-tube insertion is a simple, minimally invasive, safe, and effective interventional approach for patients with post-gastrectomy gastric fistulas.