Venous superdrained gastric tube pull-up procedure for hypopharyngeal and cervical esophageal reconstruction reduces postoperative anastomotic leakage and stricture

2017 ◽  
Vol 30 (8) ◽  
pp. 1-6 ◽  
Author(s):  
M. Fujioka ◽  
K. Hayashida ◽  
K. Fukui ◽  
S. Ishiyama ◽  
H. Saijo ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Esophageal Reconstruction

PS01.175: EVALUATION OF ASSOCIATIONS BETWEEN GASTRIC TUBE PREPARATION METHODS AND THE INCIDENCE OF CERVICAL ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY FOR THORACIC ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 99-99
Author(s):  
Yutaka Miyawaki ◽  
Hiroshi Sato ◽  
Sinich Sakuramoto ◽  
Koujun Okamoto ◽  
Shigeki Yamaguchi ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Multivariate Logistic Regression Analysis ◽  
Esophageal Reconstruction ◽  
Peripheral Blood Flow ◽  
Thoracic Esophageal Cancer ◽  
Preparation Methods ◽  
Brinkman Index ◽  
The Difference

Abstract Background In esophageal reconstruction, the gastric tube (GT) is superior in elevation and handiness of the maneuver; therefore, GT is most often selected as a reconstruction conduit. Although some leakages from esophagogastric anastomoses are induced by ischemic or congested peripheral blood flow in the reconstruction conduits, the association between the GT and the incidence of anastomotic leakage (AL) is unclear. Methods Between February 2013 and September 2017, 188 consecutive patients who underwent an esophagectomy with GT reconstruction were enrolled in this cohort study. We performed GT reconstructions using narrow gastric tubes (Gr.N) until May 2016, which is when we began preparing and using stretched GTs (Gr.S). We retrospectively evaluated the incidence of AL. Results AL occurred in 29 of 188 (15.4%) patients, and the frequency of AL occurrence in Gr.S was lower than that in Gr.N (P = 0.034). Sex, body mass index, Brinkman index, and presence of hypertension or anemia were significantly associated with AL (P = 0.033, 0.041, 0.003, 0.030, and 0.042, respectively). The multivariate logistic regression analysis suggested that the type of GT used and the Brinkman index were independent risk factors for AL (P = 0.016 and 0.020, respectively). Conclusion Our results demonstrated that the difference in the GT preparation method was an independent risk factor for AL after cervical esophagogastrostomy. We suggest that the method of GT preparation could contribute to a reduction of AL after esophagectomy. Disclosure All authors have declared no conflicts of interest.

Evaluation of the Associations between Gastric Tube Preparation Methods and the Incidence of Cervical Anastomotic Leakage after Esophagectomy for Thoracic Esophageal Cancer

2019 ◽  
Vol 37 (2) ◽  
pp. 154-162 ◽  
Author(s):  
Yutaka Miyawaki ◽  
Hiroshi Sato ◽  
Naoto Fujiwara ◽  
Hirofumi Sugita ◽  
Shinichi Sakuramoto ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Preparation Method ◽  
Multivariate Logistic Regression Analysis ◽  
Esophageal Reconstruction ◽  
Thoracic Esophageal Cancer ◽  
Preparation Methods ◽  
Brinkman Index ◽  
Flow Failure ◽  
Independent Risk Factors

Background: A gastric tube (GT) is most often selected as a reconstruction conduit in esophageal reconstruction. Although some leakage from esophagogastric anastomoses is induced by blood flow failure in reconstruction conduits, the association between the GT and the anastomotic leakage (AL) is unclear. Objectives: We retrospectively evaluated the incidence of AL according to the GT shape. Methods: Between February 2013 and September 2017, 188 consecutive patients who underwent esophagectomy with GT reconstruction were enrolled in this cohort study. We performed GT reconstruction using a narrow GT (Gr.N) until May 2016. Subsequently, we began preparing and using a stretched GT (Gr.S). Results: AL occurred in 29 of 188 (15.4%) patients. The frequency of AL was lower with Gr.S than with Gr.N (p = 0.034). Sex, body mass index, Brinkman index, hypertension, and anemia were significantly associated with AL (p = 0.033, 0.041, 0.003, 0.030, and 0.042, respectively). In a multivariate logistic regression analysis, the GT shape and the Brinkman index were shown to be independent risk factors for AL (p = 0.016 and 0.020, respectively). Conclusions: The GT preparation method is an independent risk factor for AL after cervical esophagogastrostomy. Thus, improved GT preparation methods could contribute to the reduction of AL after esophagectomy.

scholarly journals Problems in Oral Intake after Esophageal Reconstruction with Gastric Tube and its Managements.

1995 ◽  
Vol 28 (10) ◽  
pp. 2072-2076
Author(s):  
Tatsuyuki Kawano ◽  
Kunihide Yoshino ◽  
Kagami Nagai ◽  
Haruhiro Inoue ◽  
Takeshi Nagahama ◽  
...  
Keyword(s):  
Gastric Tube ◽  
Oral Intake ◽  
Esophageal Reconstruction

FA05.03: EFFECT OF EPHEDRINE ON GASTRIC CONDUIT PERFUSION MEASURED BY LASER SPECKLE CONTRAST IMAGING (LSCO) AFTER ESOPHAGECTOMY: A PROSPECTIVE IN-VIVO COHORT STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 10-10
Author(s):  
Sanne Jansen ◽  
Daniel De Bruin ◽  
Simon Strackee ◽  
Mark I Van Berge Henegouwen ◽  
Ton Van Leeuwen ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Gastric Conduit ◽  
Laser Speckle ◽  
Contrast Imaging ◽  
Laser Speckle Contrast Imaging ◽  
Speckle Contrast ◽  
Before And After ◽  
Gastric Tube Reconstruction

Abstract Background Compromised perfusion due to ligation of arteries and veins in esophagectomy with gastric tube reconstruction often (5–20%) results in necrosis and anastomotic leakage, which relate to high morbidity and mortality (3–4%). Ephedrine is used widely in anesthesia to treat intra-operative hypotension and may improve perfusion by the increase of cardiac output (CO) and mean arterial pressure (MAP). This study tests the effect of ephedrine on perfusion of the future anastomotic site of the gastric conduit, measured by Laser Speckle Contrast Imaging (LSCI). Methods This prospective, observational, in-vivo pilot study includes 26 patients undergoing esophagectomy with gastric tube reconstruction from October 2015 to June 2016 in the Academic Medical Center (Amsterdam). Perfusion of the gastric conduit was measured with LSCI directly after reconstruction and after an increase of MAP by ephedrine 5 mg. Perfusion was quantified in flux (LSPU) in four perfusion locations, from good perfusion (base of the gastric tube) towards decreased perfusion (fundus). Intra-patient differences before and after ephedrine in terms flux were statistically tested for significance with a paired t-test. Results LSCI was feasible to image gastric microcirculation in all patients. Flux (LSPU) was significantly higher in the base of the gastric tube (791 ± 442) compared to the fundus (328 ± 187) (P < 0.001). After administration of ephedrine, flux increased significantly in the fundus (P < 0·05) measured intra-patients. Three patients developed anastomotic leakage. In these patients, the difference between measured flux in the fundus compared to the base of the gastric tube was high. Conclusion This study presents the effect of ephedrine on perfusion of the gastric tissue measured with LSCI in terms of flux (LSPU) after esophagectomy with gastric tube reconstruction. We show a small but significant difference between flux measured before and after administration of ephedrine in the future anastomotic tissue (313 ± 178 vs. 397 ± 290). We also show a significant decrease of flux towards the fundus. Disclosure All authors have declared no conflicts of interest.

scholarly journals Calcification of arteries supplying the gastric tube increases the risk of anastomotic leakage after esophagectomy with cervical anastomosis

2016 ◽  
Vol 8 (12) ◽  
pp. 3551-3562 ◽  
Author(s):  
Liang Zhao ◽  
Gefei Zhao ◽  
Jiagen Li ◽  
Bin Qu ◽  
Susheng Shi ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Cervical Anastomosis

PS01.148: UTILITY OF GASTROSTOMY VIA GASTRIC TUBE AFTER ESOPHAGEAL CANCER SURGERY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 91-91
Author(s):  
Yoshihisa Matsumoto
Keyword(s):  
Esophageal Cancer ◽  
Hospital Stay ◽  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Postoperative Hospital Stay ◽  
Cancer Surgery ◽  
Recurrent Nerve ◽  
Clinicopathological Factors ◽  
Respiratory Complications ◽  
Postoperative Results

Abstract Background Esophageal cancer patients often suffer from preoperative malnutrition. It is very important for them to improve their perioperative nutrition status. In our department, we have adopted jejunostomy after esophageal cancer surgery in almost all cases. However, sometimes we have experienced catheter related complications via jejunostomy. Recently, several studies reported that gastrostomy via gastric tube might reduce the catheter related complications. In this study, we compared gastrostomy with jejunostomy as postoperative results and catheter related complications. Methods From January 2010 to November 2016, we performed 215 consecutive esophagectomy for esophageal cancer. It was divided into 133 cases of gastrostomy group (group G) and 82 cases of jejunostomy group (group J). We analyzed clinicopathological factors (age, sex, tumor localization, tumor progression degree and preoperative chemotherapy), postoperative results (anastomotic leakage, respiratory complications, recurrent nerve palsy and postoperative hospital stay) and correlation of catheter related complications retrospectively. Results There were no significant differences between the two groups in clinicopathological factors and postoperative outcomes such as anastomotic leakage, recurrent nerve paralysis and postoperative hospital stay. Respiratory complications were occurred in 12 cases (8.0%)/25 cases (31.0%) (P < 0.001). Catheter related complications were occurred in 17 cases (5 in group G (3.0%), 12 in group J (9.8%) (P = 0.005) and it was significantly less in group G. The details of catheter related complications were classified into group G (duodenal perforation and dislocation) and group J (intestinal perforation, intestinal obstruction and intestinal fluid leakage). Conclusion The rate of catheter related complications after esophagectomy via gastrostomy in this study were lower than that via jejunostomy in previous reports. We suggest the route of enteral nutrition via gastric tube is more effective than that via jejunostomy with regard to catheter related complications. Disclosure All authors have declared no conflicts of interest.

The sterno-tracheal distance is an important factor of anastomotic leakage of retrosternal gastric tube reconstruction after esophagectomy

Esophagus ◽  
2019 ◽  
Vol 17 (3) ◽  
pp. 264-269 ◽  
Author(s):  
Seiya Inoue ◽  
Takahiro Yoshida ◽  
Takeshi Nishino ◽  
Masakazu Goto ◽  
Yoshihito Furukita ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Gastric Tube Reconstruction

PS01.186: QUANTITATIVE PERFUSION EVALUATION AFTER GASTRIC TUBE RECONSTRUCTION USING FLUORESCENCE IMAGING

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 102-103 ◽  
Author(s):  
Sanne Jansen ◽  
Daniel De Bruin ◽  
Simon Strackee ◽  
Ed Van Bavel ◽  
Ton Van Leeuwen ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Anastomotic Leakage ◽  
Fluorescence Imaging ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Contact Method ◽  
Fluorescent Intensity ◽  
Fluorescent Signal ◽  
Maximal Intensity ◽  
Quantitative Parameters

Abstract Background Poor fundus perfusion is seen as the major factor for the development of anastomotic necrosis, leakage and strictures. Quantitative imaging of tissue perfusion during reconstructive surgery, therefore, may reduce the incidence of complications. Imaging the fluorescense of intravenously administered fluorophores is an optical, non-contact method to image blood flow in real-time. However, quantitative parameters for perfusion evaluation are stil lacking. The objective of this study is to test fluorescence imaging derived quantitative parameters for perfusion evaluation of the gastric tube during surgery and to correlate these parameters to patient outcome in terms of anastomotic leakage. Methods This study included 22 patients (October 2015 - June 2016). Indocyanine green (ICG) was injected intravenously and the fluorescense intensity of the gastric tube was imaged for 2–3 minutes. At 4 locations, quantitative analysis of the fluorescent intensity over time was performed to obtain perfusion related parameters: the maximal intensity, mean slope and influx timepoint. These parameters were tested for significant differences between the four perfusion areas of the gastric tube (from normal to decreased perfusion) with a repeated ANOVA test. Furthermore, these parameters and the distance of the end of the gastroepiploic artery to the fundus and distance of the demarcation of the fluorescent signal to the fundus were compared with patient outcome in terms of anastomotic leakage development. Results The fluorescent signal could be detected in all analyzed patients (n = 20). Maximal intensity, mean slope and influx timepoint were significantly different between the base of the gastric tube and the fundus (P < 0.0001). While the distance of the watershed and the demarcation of ICG to the fundus varied between patients, the distance of the demarcation of ICG to the fundus was significantly higher in the three patients who developed anastomotic leakage (P < 0.0001). No allergic reactions on ICG were witnessed. Conclusion Intra-operative fluorescence imaging is feasible to visualize perfusion quantitatively in gastric-tube surgery, using the parameters maximal intensity, mean slope and influx timepoint. A low slope and a large distance between the fluorescence demarcation and the fundus were seen in patients who developed anastomotic leakage and could therefore allow for early risk stratification of necrosis. Disclosure All authors have declared no conflicts of interest.

PS01.190: FLEXIBLE GASTRIC TUBE: A NOBLE METHOD OF GASTRIC TUBE RECONSTRUCTION WITHOUT ANASTOMOTIC LEAKAGE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 103-104
Author(s):  
Yasuaki Nakajima ◽  
Kenro Kawada ◽  
Yutaka Tokairin ◽  
Akihiro Hoshino ◽  
Takuya Okada ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Clinical Outcomes ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Circular Stapler ◽  
Anastomotic Site ◽  
Subtotal Esophagectomy ◽  
The Status ◽  
Greater Curvature ◽  
Gastric Tube Reconstruction

Abstract Background Anastomotic leakage is one of the most frequent and severe morbidities after esophagectomy. For preventing anastomotic leakage, it is important to design a gastric tube with sufficient blood supply and to perform precise anastomosis at a well-conditioned site. We herein show our method of gastric tube reconstruction and evaluate the outcome. Methods Seven hundred and forty-six esophageal carcinoma patients who received subtotal esophagectomy with gastric tube reconstruction via the retrosternal route between 1994 and 2017 were enrolled in the present study. Although we previously used a greater curvature gastric tube with a 4 cm in diameter (narrow group), since 2000, a ‘flexible gastric tube,’ which was designed on an individual basis with the aim of preserving the vascular plexus in the center of the anterior and posterior stomach wall to the maximum possible extent in order to supply a sufficient amount of blood to the tip of the gastric tube was used (flexible group). Cervical esophagogastric end-to-side anastomosis using the circular stapler was performed during the whole period. The clinical outcomes were compared between the two groups. Results Anastomotic leakage was observed in 36 (4.8%) patients. While 24 of 155 (15.5%) patients showed anastomotic leakage in the narrow group, 12 of 591 (2.0%) patients showed anastomotic leakage in the flexible group and the clinical outcomes were significantly improved. Conclusion Our method of gastric tube reconstruction helped to improve the rate of anastomotic leakage after esophagectomy. At present, we are investigating the status of the blood flow using an ICG fluorescence method and by measuring the degree of oxygen saturation and hemoglobin using a new non-invasive monitoring tool during the operation. Postoperative assessments of the anastomotic site are performed using endoscopic examinations. We herein report the results of these assessments. Disclosure All authors have declared no conflicts of interest.

Effectiveness of Sternocleidomastoid Flap Repair for Cervical Anastomotic Leakage after Esophageal Reconstruction

2014 ◽  
Vol 31 (4-5) ◽  
pp. 306-311 ◽  
Author(s):  
Masanobu Nakajima ◽  
Hitoshi Satomura ◽  
Masakazu Takahashi ◽  
Hiroto Muroi ◽  
Hiroyuki Kuwano ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Esophageal Reconstruction ◽  
Flap Repair
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