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Munoz NR, Hojjat A, Dhaliwal G, Adial A. Knotted Naso gastric Tube Removed With a Bronchoscope. Cureus 2023; 15:e40896. [PMID: 37492840 PMCID: PMC10364850 DOI: 10.7759/cureus.40896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 07/27/2023] Open
Abstract
Nasogastric (NG) tube insertion is a routine procedure performed for a variety of indications, such as delivering enteral nutrition. NG tubes can be associated with complications, including knotting of the tube. The case of a 68-year-old who was admitted to the hospital for AIDS complicated by septic shock is presented. The patient received an NG tube to provide enteral nutrition, which was subsequently found to be clogged. An X-ray of the pharynx revealed a knot at the distal end of the NG tube. The knotted NG tube was removed with a fiberoptic bronchoscope through the nostril. The knotting of an NG tube is a rare complication. Clinicians should be aware of alternative methods of removing knotted NG tubes, including the use of a fiberoptic bronchoscope.
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Affiliation(s)
| | - Armin Hojjat
- Internal Medicine, Temecula Valley Hospital, Temecula, USA
| | | | - Ajay Adial
- Pulmonology and Critical Care, Temecula Valley Hospital, Temecula, USA
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2
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Agrawal R, Yang J, Ali S, Ghoulam E, Mutneja H, Bhurwal A, Boulay B, Villa EC. Safety and Efficacy of Endoscopic Submucosal Dissection in the Management of Gastric Tube Cancers After Esophagectomy: A Systematic Review. Cureus 2023; 15:e40526. [PMID: 37461759 PMCID: PMC10350321 DOI: 10.7759/cureus.40526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Esophagectomy is the proposed standard of care for resectable primary esophageal cancers and recurrent lesions in the reconstructed gastric tube (GT); however, it carries significant morbidity and mortality. Endoscopic submucosal dissection (ESD) has established its role in the management of primary esophageal cancers with growing evidence of its safety in resecting recurrent primary lesions in GT. Our study aims to evaluate the safety and efficacy of ESD in the management of recurrent, localized primary esophageal cancers in GT. We searched PubMed, CENTRAL, EMBASE, Scopus, and clinical trial registries from inception to March 2023 for articles evaluating the safety and efficacy of ESD in the management of recurrent cancerous lesions in GT. Our primary outcome was the en bloc resection rate. Secondary outcomes were curative resection rate, complete resection rate, intra-procedural complication rate, post-procedure complication rate, and five-year survival rate. Seven studies with a total of 165 patients undergoing 192 ESDs were included in the review. The pooled en bloc resection rate was 92.5% (95% CI: 87.7-95.6), which was reported in all seven studies. Pooled complete resection rate was 78.9% (95% CI: 64.5-88.5) per three studies, pooled curative resection rate was 73.9% (95% CI: 63.5-82.2) per four studies, and pooled intra-procedural complication rate was 10.2% (95% CI: 1.5-46.3), which was reported in four studies. Only three studies reported a five-year survival rate that was 65.5% (95% CI: 56.0-73.9). ESD is safe and efficacious in the management of GT cancer after esophagectomy.
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Affiliation(s)
- Rohit Agrawal
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - James Yang
- Internal Medicine, University of Illinois at Chicago, Chicago, USA
| | - Saeed Ali
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Elie Ghoulam
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Hemant Mutneja
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Abhishek Bhurwal
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, USA
| | - Brian Boulay
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Edward C Villa
- Gastroenterology and Hepatology, NorthShore University Health System, Evanston, USA
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3
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Zarfati A, Tambucci R, Bagolan P, Conforti A. Isoperistaltic gastric tube for long gap esophageal atresia (LGEA) in newborn, infants, and toddlers: a case-control study from a tertiary center. Front Pediatr 2023; 11:1194928. [PMID: 37260794 PMCID: PMC10228820 DOI: 10.3389/fped.2023.1194928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/03/2023] [Indexed: 06/02/2023] Open
Abstract
Background Limited evidence exists about outcomes after gastric tube formation as "rescue" technique to avoid esophageal replacement in long gap esophageal atresia (LGEA). The last ERNICA Consensus Conference on the Management of LGEA has placed the techniques of gastric tubulization among the priorities for future research. Aims Evaluate personal experience with Isoperistaltic Gastric Tube (IGT) and compare its outcomes with other more popular techniques for LGEA. Methods A case-control study has been conducted. A retrospective monocentric analysis of LGEA patients (period: 2010-19) has been conducted in all consecutive IGT patients and each of these has been type matched with two cases of LGEA treated with other techniques. The follow-up (FU) considered was 24-months. Results IGT and controls showed no statistically significant differences regarding preoperative variables like sex, gestational age, birth weight, syndromes, and EA type. However, IGT patients had a significantly longer esophageal GAP under boost pressure (4.5 vertebral bodies vs. 3.6, p = 0.019) at time of surgery. The analysis showed no statistical difference among the two groups about perioperative outcomes, ICU, or overall postoperative stay. No differences have been shown between IGT and controls during the follow-up regarding GERD, esophagitis, fundoplication, dysphagia, vocal cord paralysis, stenosis, and dilatations, auxologic data, need for anastomosis revision, oral aversion, and death. Conclusions Isoperistaltic Gastric Tube is safe and effective even in LGEA patients with longer gaps, with good perioperative, post-operative and middle-term outcomes. This procedure may be considered as an alternative to avoid esophageal substitution when a primary anastomosis seems impossible for a residual gap after traction and growth techniques.
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Affiliation(s)
- Angelo Zarfati
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Neonatal Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Pietro Bagolan
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Neonatal Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Andrea Conforti
- Neonatal Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Muacevic A, Adler JR, Asiri D, Yaqoub N, Alfraih S, Chachar YS, Jamil SF. A Comparison Between the Complications of Laparoscopic and Open Gastrostomy Tube Insertions: A Single-Center Study From Riyadh, Saudi Arabia. Cureus 2022; 14:e31992. [PMID: 36589165 PMCID: PMC9797873 DOI: 10.7759/cureus.31992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background and objective Gastrostomy is a procedure that involves placing a feeding tube through the abdominal wall into the stomach to provide nutritional support. There are several modes of gastrostomy tube insertion including laparoscopic-assisted gastrostomy (LAG), percutaneous endoscopic gastrostomy (PEG), and open gastrostomy (OG) procedure, among others. Although it is a widely performed procedure, limited data is available regarding gastrostomy in Saudi Arabia, specifically among the pediatric population. This study aimed to shed more light on different aspects of surgical gastrostomy procedures among pediatric patients at the King Abdullah Specialist Children's Hospital (KASCH) in Riyadh, Saudi Arabia. The main objective of our study was to report the indications and complications of both LAG and OG insertions in the pediatric population. Methods A retrospective cross-sectional study was conducted at KASCH to analyze the different parameters related to LAG and OG insertions, and to evaluate for any association between these modes of insertion and their complications. Pertinent data on children from birth to 14 years of age were collected through consecutive sampling using a chart review. A total of 107 pediatric patients who underwent the procedure from 2016 to 2020 were evaluated. Results Demographically, the majority (58%) of gastrostomies were performed in infants (less than a year old). Additionally, our study showed a significantly increased association between LAG and complications such as discharge, (27.12%), skin manifestations (27.12%), and bleeding (10.17%) when compared to OG. Conclusion Based on our findings, LAG showed less favorable outcomes in contrast to OG. Further studies should be conducted to validate our findings and ensure consistent results and outcomes among different methods of gastrostomy tube insertion.
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Takabatake K, Konishi H, Kubota T, Shiozaki A, Fujiwara H, Ohashi T, Arita T, Shimizu H, Yamamoto Y, Morimura R, Ikoma H, Kuriu Y, Okamoto K, Otsuji E. Postoperative Nutrition Status of Patients With Esophago-gastric Junction Cancer With Gastric Tube or Esophago-gastric Reconstruction. Anticancer Res 2022; 42:3645-3652. [PMID: 35790280 DOI: 10.21873/anticanres.15853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/11/2022] [Accepted: 05/23/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Postoperative nutritional management for esophago-gastric junction cancer (EGJC) has become increasingly important. This study compared the nutritional status of patients with EGJC who underwent gastric tube reconstruction versus esophago-gastric anastomosis. PATIENTS AND METHODS Mediastinoscopic esophagectomy with gastric tube reconstruction was performed in 17 cases (group GT) and laparoscopic proximal gastrectomy with esophago-gastric anastomosis in 33 cases (group EG). The perioperative characteristics and nutritional status of the two groups in the 2 years postoperatively were compared. RESULTS Group GT had a significantly higher level of serum total protein at 24 months postoperatively than did group EG. No other significant differences in postoperative nutritional status were observed between the groups. CONCLUSION Gastric tube reconstruction for EGJC was not inferior to esophago-gastric anastomosis in terms of nutritional status. It is a candidate surgical procedure to avoid higher mediastinal anastomosis.
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Affiliation(s)
- Kazuya Takabatake
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirotaka Konishi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Kubota
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsushi Shiozaki
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Fujiwara
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuma Ohashi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomohiro Arita
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroki Shimizu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yusuke Yamamoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryo Morimura
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisashi Ikoma
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshiaki Kuriu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuma Okamoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Valla FV, Cercueil E, Morice C, Tume LN, Bouvet L. Point-of-Care Gastric Ultrasound Confirms the Inaccuracy of Gastric Residual Volume Measurement by Aspiration in Critically Ill Children: GastriPed Study. Front Pediatr 2022; 10:903944. [PMID: 35783320 PMCID: PMC9240217 DOI: 10.3389/fped.2022.903944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/09/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction No consensus exists on how to define enteral nutrition tolerance in critically ill children, and the relevance of gastric residual volume (GRV) is currently debated. The use of point-of-care ultrasound (POCUS) is increasing among pediatric intensivists, and gastric POCUS may offer a new bedside tool to assess feeding tolerance and pre-procedural status of the stomach content. Materials and Methods A prospective observational study was conducted in a tertiary pediatric intensive care unit. Children on mechanical ventilation and enteral nutrition were included. Gastric POCUS was performed to assess gastric contents (empty, full of liquids or solids), and gastric volume was calculated as per the Spencer formula. Then, GRV was aspirated and measured. The second set of gastric POCUS measurements was performed, similarly to the first one performed prior to GRV measurement. The ability of GRV measurement to empty the stomach was compared to POCUS findings. Both GRV and POCUS gastric volumes were compared with any clinical signs of enteral feeding intolerance (vomiting). Results Data from 64 children were analyzed. Gastric volumes were decreased between the POCUS measurements performed pre- and post-GRV aspiration [full stomach, n = 59 (92.2%) decreased to n = 46 (71.9%), p =0.001; gastric volume: 3.18 (2.40-4.60) ml/kg decreased to 2.65 (1.57-3.57), p < 0.001]. However, the stomach was not empty after GRV aspiration in 46/64 (71.9%) of the children. There was no association between signs of enteral feeding intolerance and the GRV obtained, nor with gastric volume measured with POCUS. Discussion Gastric residual volume aspiration failed to empty the stomach and appeared unreliable as a measure of gastric emptiness. Gastric POCUS needs further evaluation to confirm its role.
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Affiliation(s)
- Frederic V. Valla
- Department of Pediatrics, Pediatric Intensive Care, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
- Department of Pediatric Intensive Care Alder Hey Children's Hospital, School of Health & Society, University of Salford, Manchester, United Kingdom
| | - Eloise Cercueil
- Department of Pediatrics, Pediatric Intensive Care, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
| | - Claire Morice
- Department of Pediatrics, Pediatric Intensive Care, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
| | - Lyvonne N. Tume
- Department of Pediatric Intensive Care Alder Hey Children's Hospital, School of Health & Society, University of Salford, Manchester, United Kingdom
| | - Lionel Bouvet
- Department of Anesthesiology and Intensive Care, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
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Ishikawa Y, Breuler C, Chang AC, Lin J, Orringer MB, Lynch WR, Lagisetty KH, Wakeam E, Reddy RM. Quantitative perfusion assessment of gastric conduit with indocyanine green dye to predict anastomotic leak after esophagectomy. Dis Esophagus 2022; 35:6463426. [PMID: 34913060 DOI: 10.1093/dote/doab079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/25/2021] [Indexed: 12/11/2022]
Abstract
Impaired gastric conduit perfusion is a risk factor for anastomotic leak after esophagectomy. The aim of this study is to evaluate the feasibility of intraoperative quantitative assessment of gastric conduit perfusion with indocyanine green fluorescence angiography as a predictor for cervical esophagogastric anastomotic leak after esophagectomy. Indocyanine green fluorescence angiography using the SPY Elite system was performed in patients undergoing a transhiatal or McKeown esophagectomy from July 2015 through December 2020. Ingress (dye uptake) and Egress (dye exit) at two anatomic landmarks (the tip of a conduit and 5 cm from the tip) were assessed. The collected data in the leak group and no leak group were compared by univariate and multivariable analyses. Of 304 patients who were evaluated, 70 patients developed anastomotic leak (23.0%). There was no significant difference in patients' demographic between the groups. Ingress Index, which represents a proportion of blood inflow, at both the tip and 5 cm of the conduit was significantly lower in the leak group (17.9 vs. 25.4% [P = 0.011] and 35.9 vs. 44.6% [P = 0.019], respectively). Ingress Time, which represents an estimated time of blood inflow, at 5 cm of the conduit was significantly higher in the leak group (69.9 vs. 57.1 seconds, P = 0.006). Multivariable analysis suggested that these three variables can be used to predict future leak. Variables of gastric conduit perfusion correlated with the incidence of cervical esophagogastric anastomotic leak. Intraoperative measurement of gastric conduit perfusion can be predictive for anastomotic leak following esophagectomy.
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Affiliation(s)
- Yoshitaka Ishikawa
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Christopher Breuler
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrew C Chang
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jules Lin
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Mark B Orringer
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - William R Lynch
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kiran H Lagisetty
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Elliot Wakeam
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Rishindra M Reddy
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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Ishii K, Tsubosa Y, Mayanagi S, Inoue M, Haneda R. Tissue Oxygen Saturation during Gastric Tube Reconstruction with Cervical Anastomosis for Esophagectomy: A Case Series. J INVEST SURG 2021; 35:809-813. [PMID: 34542377 DOI: 10.1080/08941939.2021.1968080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND One cause of anastomotic leakage after radical esophagectomy is blood flow insufficiency at the cervical anastomosis site. . METHODS Eighteen patients, who underwent radical esophagectomy with gastric tube reconstruction, were studied. The regional tissue oxygen saturation (rSO2) was measured at the tip (point pre 0) and 2, 4, and 6 cm on the distal side of the tip (point pre 1, pre 2, and pre 3, respectively) before the gastric tube was raised to the cervical site through the retrosternal route. After that, rSO2 was measured at the tip, 2 and 4 cm on the distal side of the tip (points post 0, post 1, and post 2), the actual anastomotic site (point AN), and the chest skin as an indicator of whole-body oxygenation. The relationship between rSO2 scores and the rate of anastomotic leakage was determined. RESULTS The mean rSO2 at pre 0, pre 1, pre 2, and pre 3 were 48.9%, 52.3%, 54.8%, and 56.9%, respectively (p < 0.05). The mean rSO2 at post 0, post 1, and post 2 were 47.8%, 50.5%, and 52.3%, respectively, and the rSO2 at point AN was 52.1%.Anastomotic leakage was found in 6 patients. The rSO2 at points pre 0, pre 1, and pre 2, post 0 and point AN were significantly lower in patients with anastomosis leakage than those without (p < 0.05). CONCLUSION Tissue oxygen saturation monitoring was a useful indicator of blood flow insufficiency in the gastric tube during radical esophagectomy.
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Affiliation(s)
- Kenjiro Ishii
- Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yasuhiro Tsubosa
- Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shuhei Mayanagi
- Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masazumi Inoue
- Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Ryoma Haneda
- Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
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9
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Liu D, Zhao D, Luo Z, Jin L, Ding L. The application of standardized nursing assessment and intervention in reducing the incidence of unplanned extubation of gastric tube. Am J Transl Res 2021; 13:5374-5379. [PMID: 34150133 PMCID: PMC8205823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The goal of this study was to explore the application of standardized nursing assessment and intervention in reducing the incidence of unplanned extubation of gastric tube. METHODS 100 patients with indwelling gastric tube admitted to our hospital from November 2018 to November 2019 were recruited, and according to the order of admission, they were divided into an experimental group and a control group, with 50 patients in each group. Patients in the control group received routine care, while patients in the experimental group received standardized care. The clinical indicators, incidence of slipping of the catheter, nursing disputes, complications, pain relief time and swelling relief time, unplanned extubation of the gastric tube, nursing and patient satisfaction rate, and extubation time were compared between the two groups. RESULTS The rates of success intubation and indwelling compliance in experimental group were higher than those in the control group (P<0.05). The experimental group exhibited smaller probability of catheter blockage compared with the control group (P<0.05). The incidence of complications was observed to be lower in the experimental group compared with the control group (P<0.05). We identified no statistical difference in catheter slippage and nursing disputes in the two groups (P>0.05). Regarding the 'nursing and patient satisfaction, the experimental group displayed significantly higher score in comparison with the control group (P<0.05). Furthermore, the extubation time, the pain relief time and swelling relief time in experimental group were found to be shorter (P<0.05). The unplanned gastric tube extubation rate of the experimental group was obviously lower than that of the control group's (P<0.05). CONCLUSION The incidence of unplanned gastric extubation tube and occurrence of complications and unexpected situations of patients can be reduced significantly through standardized nursing evaluation and intervention, which should be widely promoted and adopted in clinical practice.
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Affiliation(s)
- Dandan Liu
- Neurosurgery Department, Jingmen No. 2 People’s HospitalJingmen, Hubei Province, China
| | - Dan Zhao
- Nursing Department, Jingmen No. 2 People’s HospitalJingmen, Hubei Province, China
| | - Zaiping Luo
- Operating Room, Jingmen No. 2 People’s HospitalJingmen, Hubei Province, China
| | - Ling Jin
- Neurosurgery Department, Jingmen No. 2 People’s HospitalJingmen, Hubei Province, China
| | - Li Ding
- People’s Hospital of Lanling CountyLinyi, Shandong Province, China
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Nederlof N, Tilanus HW, de Vringer T, van Lanschot JJB, Willemsen SP, Hop WCJ, Wijnhoven BPL. A single blinded randomized controlled trial comparing semi-mechanical with hand-sewn cervical anastomosis after esophagectomy for cancer (SHARE-study). J Surg Oncol 2020; 122:1616-1623. [PMID: 32989770 PMCID: PMC7821322 DOI: 10.1002/jso.26209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim was to compare leak rate between hand-sewn end-to-end anastomosis (ETE) and semi-mechanical anastomosis (SMA) after esophagectomy with gastric tube reconstruction. BACKGROUND DATA The optimal surgical technique for creation of an anastomosis in the neck after esophagectomy is unclear. METHODS Patients with esophageal cancer undergoing esophagectomy with gastric tube reconstruction and cervical anastomosis were eligible for participation after written informed consent. Patients were randomized in 1:1 ratio. Primary endpoint was anastomotic leak rate defined as external drainage of saliva from the site of the anastomosis or intra-thoracic manifestation of leak. Secondary endpoints included anastomotic stricture rate at one year follow up, number of endoscopic dilatations, dysphagia-score, hospital stay, morbidity, and mortality. Patients were blinded for intervention. RESULTS Between August 2011 and July 2014, 174 patients with esophageal cancer underwent esophagectomy. Ninety-three patients were randomized to ETE (n = 44) or SMA (n = 49). Anastomotic leak occurred in 9 of 44 patients (20%) in the ETE group and 12 of 49 patients (24%) in the SMA group (absolute difference 4%, 95% CI -13% to +21%; p = .804). There was no significant difference in dysphagia at 1 year postoperatively (ETE 25% vs. SMA 20%; p = .628), in stricture rate (ETE 25% vs. 19% in SMA, p = .46), nor in median hospital stay (17 days in the ETE group, 13 days in the SMA group), morbidity (82% vs. 73%, p = .460) or mortality (0% vs. 4%, p = .175) between the groups.
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Affiliation(s)
- Nina Nederlof
- Department of Surgery, Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Hugo W Tilanus
- Department of Surgery, Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Tahnee de Vringer
- Department of Surgery, Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jan J B van Lanschot
- Department of Surgery, Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Sten P Willemsen
- Department of Biostatistics, Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wim C J Hop
- Department of Biostatistics, Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
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11
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Maeda T, Tachibana T, Harada T. Esophageal perforation with oro gastric tube malposition in low-birth-weight infant. Clin Case Rep 2019; 7:1794-1795. [PMID: 31534753 PMCID: PMC6745443 DOI: 10.1002/ccr3.2321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/26/2019] [Indexed: 11/28/2022] Open
Abstract
Esophageal perforation is an uncommon, but serious complication which can be caused with gastric tube placement. Physicians should suspect the malposition of the gastric tube when there is a straight course of the lower segment of the tube.
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Affiliation(s)
- Takashi Maeda
- Department of Pediatric Cardiology and NeonatologyOgaki Municipal HospitalJapan
| | - Takashi Tachibana
- Department of Pediatric Cardiology and NeonatologyOgaki Municipal HospitalJapan
| | - Toru Harada
- Department of Pediatric SurgeryOgaki Municipal HospitalJapan
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Laméris W, Eshuis WJ, Cuesta MA, Gisbertz SS, van Berge Henegouwen MI. Optimal mobilization of the stomach and the best place in the gastric tube for intrathoracic anastomosis. J Thorac Dis 2019; 11:S743-S749. [PMID: 31080653 DOI: 10.21037/jtd.2019.01.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Esophagectomy with gastric tube reconstruction is a highly complex surgical procedure. With regard to mobilization of the stomach and optimal gastric tube preparation and anastomosis, there are several important intraoperative steps that can influence the outcome of the operation. This study aims to describe the optimal mobilization of the stomach for gastric tube reconstruction and explore the best place in the gastric tube for intrathoracic anastomosis after esophagectomy. A search of the literature was performed and results are described in a descriptive review. Based on literature and our own experience we describe important operating steps for laparoscopic stomach mobilisation for gastric tube reconstruction. Steps to create additional length include preserving the left gastroepiploic artery, transecting the right gastric artery, extended duodenal mobilization, and duodenal diversion with roux-Y reconstruction. Several techniques for intrathoracic anastomosis are described in literature. Several imaging techniques, of which fluorescence imaging is the most commonly used, are available to assess the vascularization of the gastric tube and to assist in determining the best place in the gastric tube for intra thoracic anastomosis. Although there is little evidence of exact technique on stomach mobilization and location for an intrathoracic anastomosis, many techniques are used by different authors with varying results.
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Affiliation(s)
- Wytze Laméris
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Wietse J Eshuis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Miguel A Cuesta
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
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13
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Youn JK, Park T, Kim SH, Han JW, Jang HJ, Oh C, Moon JS, Choi YH, Park KW, Jung SE, Kim HY. Prospective evaluation of clinical outcomes and quality of life after gastric tube interposition as esophageal reconstruction in children. Medicine (Baltimore) 2018; 97:e13801. [PMID: 30593168 PMCID: PMC6314723 DOI: 10.1097/md.0000000000013801] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/30/2018] [Indexed: 02/05/2023] Open
Abstract
Few studies on gastric tube interposition for esophageal reconstruction in children have assessed the long-term outcomes and quality of life (QoL). The aim of this study is to evaluate the long-term outcomes and QoL after a gastric tube interposition by reviewing our experiences with esophageal reconstruction.Twenty-six patients were included who underwent gastric tube interposition from 1996 to 2011 at our institution. We reviewed the medical records and conducted telephone surveys, prospectively performed esophagography, endoscopy, 24-hour pH monitoring, and esophageal manometry. The median follow-up period of 12 (range, 3-18) years.Median age at the time of surgery and survey were 9 (range, 2-50) months and 12.4 (range, 3.1-19.0) years, respectively. There were 14 cases of reoperation of gross type C and B esophageal atresia (EA) and 10 cases of long gap pure EA. The z scores of anthropometric data at the survey did not increase after the operation. Severe stricture in esophagography was observed in 20% of patients, but improved with balloon dilation with intact passage. Gastroesophageal reflux was able to be treated with medications. Esophageal peristalsis was observed in 1 of 8 patients in manometry. No Barrett esophagus or metaplasia was not found from endoscopy. QoL was similar to the general population and did not differ between age groups.Gastric tube interposition could be considered for esophageal reconstruction in pediatric patients when native esophageal anastomosis is impossible. Nutritional evaluation and support with consecutive radiological evaluation to assess the anastomosis site stricture are advised.
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Affiliation(s)
- Joong Kee Youn
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul
| | - Taejin Park
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon
| | - Soo-Hong Kim
- Department of Pediatric Surgery, Pusan National University Yangsan Hospital, Yangsan
| | - Ji-Won Han
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul
| | - Hyo-Jeong Jang
- Department of Pediatrics, Keimyung University, Dongsan Medical Center, Daegu
| | - Chaeyoun Oh
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul
| | | | - Young Hun Choi
- Department of Radiology, Seoul National University Children's Hospital
| | - Kwi-Won Park
- Department of Surgery, Chung-Ang University Hospital
| | - Sung-Eun Jung
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Korea
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14
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Jansen SM, Almasian M, Wilk LS, de Bruin DM, van Berge Henegouwen MI, Strackee SD, Bloemen PR, Meijer SL, Gisbertz SS, van Leeuwen TG. Feasibility of Optical Coherence Tomography (OCT) for Intra-Operative Detection of Blood Flow during Gastric Tube Reconstruction. Sensors (Basel) 2018; 18:E1331. [PMID: 29693606 PMCID: PMC5982600 DOI: 10.3390/s18051331] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/15/2018] [Accepted: 04/21/2018] [Indexed: 01/09/2023]
Abstract
In this study; an OCT-based intra-operative imaging method for blood flow detection during esophagectomy with gastric tube reconstruction is investigated. Change in perfusion of the gastric tube tissue can lead to ischemia; with a high morbidity and mortality as a result. Anastomotic leakage (incidence 5⁻20%) is one of the most severe complications after esophagectomy with gastric tube reconstruction. Optical imaging techniques provide for minimal-invasive and real-time visualization tools that can be used in intraoperative settings. By implementing an optical technique for blood flow detection during surgery; perfusion can be imaged and quantified and; if needed; perfusion can be improved by either a surgical intervention or the administration of medication. The feasibility of imaging gastric microcirculation in vivo using optical coherence tomography (OCT) during surgery of patients with esophageal cancer by visualizing blood flow based on the speckle contrast from M-mode OCT images is studied. The percentage of pixels exhibiting a speckle contrast value indicative of flow was quantified to serve as an objective parameter to assess blood flow at 4 locations on the reconstructed gastric tube. Here; it was shown that OCT can be used for direct blood flow imaging during surgery and may therefore aid in improving surgical outcomes for patients.
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Affiliation(s)
- Sanne M Jansen
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
- Department of Plastic, Reconstructive & Hand Surgery, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Mitra Almasian
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Leah S Wilk
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Daniel M de Bruin
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Mark I van Berge Henegouwen
- Department of Surgery, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Simon D Strackee
- Department of Plastic, Reconstructive & Hand Surgery, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Paul R Bloemen
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Sybren L Meijer
- Department of Pathology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Suzanne S Gisbertz
- Department of Surgery, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Ton G van Leeuwen
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
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15
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Zhong H, Li X, Liang H, Liu N, Liu Y, Zhang J, Wu X. [Tubular gastric elongation surgery for high esophageal-gastric anastomosis after resection of esophageal cancer: analysis of 5 cases]. Nan Fang Yi Ke Da Xue Xue Bao 2018; 38:123-124. [PMID: 33177022 DOI: 10.3969/j.issn.1673-4254.2018.01.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To summarize our experience with tubular gastric elongation surgery for management of insufficient gastric length for high esophageal-gastric anastomosis following esophageal carcinoma resection. METHODS From September, 2015 to October 2016, 5 patients with esophageal cancer were treated in our department, including two with cervical esophageal cancer and 3 with thoracic esophageal cancer. The patients with cervical esophageal cancer underwent pharyngeal resection, total laryngectomy, esophageal varus extubation and gastric oropharyngeal anastomosis, and the patients with thoracic esophageal cancer underwent esophageal cancer resection with incisions on the left neck, the right chest and the median abdomen. During the surgery, the length of the stomach was found insufficient to allow routine oropharyngeal anastomosis, and tubular gastric elongation was conducted to extend the tubular stomach to enable successful completion of the surgery. RESULTS All the patients recovered smoothly after the surgery and were discharged after 2-3 weeks. CONCLUSIONS Tubular gastric elongation surgery can be a good choice for high esophageal-gastric anastomosis after resection of esophageal cancer in cases of insufficient tubular stomach length or high tension at the anastomosis.
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Affiliation(s)
- Hai Zhong
- Department of Thoracic Surgery, Southern Hospital, Southern Medical University, Guangzhou 510515, China
| | - Xiang Li
- Department of Thoracic Surgery, Southern Hospital, Southern Medical University, Guangzhou 510515, China
| | - Hongsen Liang
- Department of Thoracic Surgery, Southern Hospital, Southern Medical University, Guangzhou 510515, China
| | - Nanbo Liu
- Department of Thoracic Surgery, Southern Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yufan Liu
- Department of Thoracic Surgery, Southern Hospital, Southern Medical University, Guangzhou 510515, China
| | - Junhua Zhang
- Department of Thoracic Surgery, Southern Hospital, Southern Medical University, Guangzhou 510515, China
| | - Xu Wu
- Department of Thoracic Surgery, Southern Hospital, Southern Medical University, Guangzhou 510515, China
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Abstract
Background and Aims: The existence of several methods for proper placement of nasogastric tube (NGT) and introduction of various novel methods day-by-day indicates that no method is perfect or universally accepted. However, the quest for the best is still on. Application of cold in various forms to stiffen the NGT has been tested inconsistently over the last three decades. In the recent past, frozen NGT has been compared only with conventional methods. Hence, the present study was designed to evaluate the efficacy of the frozen technique in comparison with conventional and reverse Sellick's manoeuvre. Methods: A total of 195 adult patients undergoing abdominal surgeries in anaesthetised and intubated state requiring NGT insertion were allocated to three groups to have their NGT placement using either the conventional method (Group A) or using frozen NGT (Group B) or applying reverse Sellick's manoeuvre (Group C). The number of successful placements of NGT within two attempts, procedure time, and incidences of adverse events were noted. Results: The highest success rate regarding the successful placement of NGT was observed using reverse Sellick's manoeuvre (95.2%), closely followed by the frozen NGT technique (84.6%) in comparison with conventional method (69.2%). The procedure time was the least with reverse Sellick's manoeuvre (31.5 ± 9.5 s) compared with conventional (42.2 ± 21.4 s) and frozen technique (42.1 ± 13.2 s). Conclusion: Nasogastric tube insertion using reverse Sellick's manoeuvre shows the highest success rate and having the least adverse events among the compared three methods in anaesthetised, intubated adult patients.
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Affiliation(s)
- Mohanchandra Mandal
- Department of Anaesthesiology, N.R.S. Medical College, Kolkata, West Bengal, India
| | - Anirban Karmakar
- Department of Anaesthesiology, Siliguri District Hospital, Siliguri, West Bengal, India
| | - Sekhar Ranjan Basu
- Department of Anaesthesiology, North Bengal Medical College, Siliguri, West Bengal, India
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Verma V, Allen PK, Lin SH. Evaluating Factors for Prophylactic Feeding Tube Placement in Gastroesophageal Cancer Patients Undergoing Chemoradiotherapy. Front Oncol 2017; 7:235. [PMID: 29021972 PMCID: PMC5623934 DOI: 10.3389/fonc.2017.00235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/12/2017] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Though better studied in head/neck cancers, there are currently no studies on timing of feeding tube (FT) placement in patients with gastroesophageal cancer. This study sought to discern characteristics of patients who used versus did not use a prophylactic FT (pFT), and also analyzed factors associated with placement of FTs during chemoradiotherapy (CRT). METHODS/MATERIALS From 1998 to 2013, 1,329 patients underwent neoadjuvant CRT, of which 323 received an FT. Patients for whom FTs were placed prior to treatment due to tumor occlusion or substantial weight loss (n = 130), and those with FTs placed following treatment (n = 43) were excluded. One hundred patients had pFTs placed, and 50 underwent placement during CRT. The following was collected for each patient: demographic/patient information, oncologic/treatment characteristics, and CRT tolerance. RESULTS No significant differences were found in any parameter between cohorts that used (n = 66) versus did not use a pFT (n = 34); on univariate and multivariate analyses, no pretreatment characteristic associated with using a pFT. When compared with patients who used a pFT (n = 66), those who required an FT during CRT (n = 50) had lower body mass index (p = 0.045), underwent higher-dose radiotherapy (p = 0.003), and received induction chemotherapy (p = 0.031). On multivariate analysis, receipt of induction chemotherapy and greater weight loss and esophagitis during treatment were associated with placement of FTs during CRT (p < 0.05). CONCLUSION Of our cohort who received pFTs, there were no clinical factors that predicted for their use. Patients must be closely monitored for weight loss and esophagitis when receiving CRT in order to intervene prior to further worsening of toxicities.
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Affiliation(s)
- Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Pamela K. Allen
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Steven H. Lin
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
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18
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Kitagawa H, Namikawa T, Iwabu J, Hanazaki K. Gastric Tube Reconstruction with Superdrainage Using Indocyanine Green Fluorescence During Esophagectomy. In Vivo 2017; 31:1019-1021. [PMID: 28882975 DOI: 10.21873/invivo.11163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/04/2017] [Accepted: 08/06/2017] [Indexed: 02/08/2023]
Abstract
We report a case of gastric tube reconstruction with superdrainage using indocyanine green fluorescence during esophagectomy for esophageal cancer. A 53-year-old man with a history of early esophageal cancer treated with endoscopic mucosal dissection experienced esophageal cancer recurrence. There was no evidence of lymph node involvement or distant metastasis on computed tomography; therefore, we performed thoracoscopic esophagectomy. After thoracoscopic esophagectomy, we created a gastric tube. When pulling up the gastric tube through the post-mediastinum route, a root of the right gastroepiploic vein was injured. We subsequently performed superdrainage to avoid congestion of the gastric tube with omental vein and pre-tracheal vein anastomosis at the neck, and confirmed venous flow using the indocyanine green fluorescence method. No postoperative anastomotic leakage was observed, and the patient was discharged 22 days after surgery. Thus, we recommend the indocyanine green fluorescence method in cases involving superdrainage during esophagectomy.
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Affiliation(s)
| | | | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Nankoku, Japan
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19
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Bharathi RS. Efficacy of camera sleeve in conveyance of conduits. Pol Przegl Chir 2017; 89:76-83. [PMID: 28522789 DOI: 10.5604/01.3001.0009.6010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Esophageal substitutes need conveyance from the abdomen into the neck for restoration of alimentary continuity. Reports suggest that the use of plastic camera sleeve may prove advantageous in restoring conveyance. This study aims to evaluate the practicability of this approach, specifically, in laparoscopy-assisted surgeries. METHODS The efficacy of camera sleeve in conduit transposition was prospectively evaluated over 2 years. The following parameters were assessed: success/failure; time taken; blood loss; adequacy of length of the conduit delivered into the neck; conduit orientation; ease of procedure through different routes; conduit damage; complications; and drawbacks. RESULTS The technique was used in 25 consecutive patients. Two ileo-colonic, 13 gastric, and 10 colonic conduits were transposed. Posterior mediastinal, retro-sternal, and ante-sternal routes were used in 15, 8, and 2 cases, respectively. There were no failures. The technique was easy to adopt. It added < 10 minutes to the procedure. It entailed no additional blood loss. Adequate length of the conduit was transposed into the neck, atraumatically. Conduits maintained their orientation without effort. Although no complications per se were associated with its use, extra conduit length became transposed into the neck, twice, necessitating its trimming/adjustment. In one case, traction suture became avulsed from the conduit, midway in the tunnel. This could easily be rectified by pulling out the sleeve from the neck, which brought up the conduit along with it, as desired. CONCLUSIONS Use of camera sleeve proves efficacious in interposition of esophageal substitutes.
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Abstract
In esophageal cancer surgery, perfusion of the gastric conduit is a critical issue. Measurement of gastric intramucosal pH (pHi) is a method to identify anaerobic metabolism as a sign of impaired perfusion. In this study we aimed to monitor changes in the perfusion of the gastric conduit at key steps during and after esophagectomy. pHi was measured per- and postoperatively using intermittent gastric tonometry in 32 patients undergoing open, 65%, or video-assisted thoracoscopic esophagectomy for esophageal cancer. Measurements focused on the surgical steps when the vascular supply to the gastric conduit was altered. A tonometry catheter was successfully placed in all patients and a decrease in pHi (mean ± SD) was observed from baseline to after the division of the short gastric vessels (7.33 ± 0.07 to 7.29 ± 0.07, P = 0.005). A further reduction after the ligation of the left gastric artery (7.26 ± 0.08, P < 0.001) and after final linear stapling the gastric conduit (7.15 ± 0.13, P < 0.001) was observed. Two hours after surgery, pHi increased (7.24 ± 0.09, P = 0.002). In contrast to open surgery, a trend towards less reduction in pHi was seen in thoracoscopic surgery. Patients with anastomotic leaks had lower pHi on the first postoperative day (7.12 ± 0.05 vs. 7.27 ± 0.08, P = 0.040). It can be concluded that each surgical step altering the vascular supply to the gastric conduit resulted in detectable changes, however transient, in pHi. Patients with low pHi on the first postoperative day were more prone to have clinically relevant anastomotic leaks.
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Affiliation(s)
- Gustav Linder
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Jakob Hedberg
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Martin Björck
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Abstract
Replacement of the esophagus in children can be performed in cases of malformations, injuries, or acquired conditions. The new esophagus should allow normal oral feeding, with little or no gastroesophageal reflux, and be able to work well for the lifetime of the patient. For over a century, many substitutes have been used, such as segments of colon, the entire stomach, gastric tubes, or parts of the small bowel, but none are perfect or function like a normal esophagus. Esophageal replacements are demanding challenges for pediatric surgeons. Here, I review the different techniques and the pitfalls related to these procedures on the basis of our experience of more than 300 esophageal replacements in children performed since 1989.
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Affiliation(s)
- Olivier Reinberg
- Department of Pediatric Surgery, University Hospital and University of Lausanne, Pully, Switzerland.
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Choudhury SR, Yadav PS, Khan NA, Shah S, Debnath PR, Kumar V, Chadha R. Pediatric esophageal substitution by gastric pull-up and gastric tube. J Indian Assoc Pediatr Surg 2016; 21:110-4. [PMID: 27365902 PMCID: PMC4895733 DOI: 10.4103/0971-9261.182582] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim: The aim of this study was to report the results of pediatric esophageal substitution by gastric pull-up (GPU) and gastric tube (GT) from a tertiary care pediatric center. Materials and Methods: Retrospective analysis of the surgical techniques, results, complications, and final outcome of all pediatric patients who underwent esophageal substitution in a single institution was performed. Results: Twenty-four esophageal substitutions were performed over 15-year period. The indications were pure esophageal atresia (EA)-19, EA with distal trachea-esophageal fistula-2, EA with proximal pouch fistula-1, and esophageal stricture in two patients. Mean age and weight at operation were 17 months and 9.5 kg, respectively. GPU was the most common procedure (19) followed by reverse GT (4) and gastric fundal tube (1). Posterior mediastinal and retrosternal routes were used in 17 and 7 cases, respectively. Major complications included three deaths in GPU cases resulting from postoperative tachyarrhythmias leading to cardiac arrest, cervical anastomotic leak-17, and anastomotic stricture in six cases. Perioperative tachyarrhythmias (10/19) and transient hypertension (2/19) were observed in GPU patients, and they were managed with beta blocker drugs. Postoperative ventilation in Intensive Care Unit was performed for all GPU, but none of the GT patients. Follow-up ranged from 6 months to 15 years that showed short-term feeding difficulties and no major growth-related problems. Conclusions: Perioperative tachyarrhythmias are common following GPU which mandates close intensive care monitoring with ventilation and judicious use of beta blocking drugs. Retrosternal GT with a staged neck anastomosis can be performed without postoperative ventilation.
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Affiliation(s)
- Subhasis Roy Choudhury
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Partap Singh Yadav
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Niyaz Ahmed Khan
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Shalu Shah
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Pinaki Ranjan Debnath
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Virendra Kumar
- Department of Paediatric Intensive Care, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Rajiv Chadha
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
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23
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Zhang R, Wang P, Zhang X, Zhang L, Li C. Gastric tube reconstruction prevents postoperative recurrence and metastasis of esophageal cancer. Oncol Lett 2016; 11:2507-2509. [PMID: 27073507 DOI: 10.3892/ol.2016.4240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 10/09/2015] [Indexed: 11/06/2022] Open
Abstract
Esophagectomy is the main method of treating patients with esophageal cancer. Tubular stomach and whole stomach approaches may be used for esophagectomy. However, it is not known to what extent these surgical methods are associated with postoperative recurrence and metastasis. Therefore, we aimed to investigate the effect of the tubular and whole stomach approaches on postoperative recurrence and metastasis in esophageal cancer patients. One hundred and twenty-one patients that were diagnosed with esophageal cancer by gastroscopic biopsy between March 2010 and March 2011 in Taian Central Hospital, China, were recruited into this study. There were 67 cases in the gastric tube group and 54 cases in whole stomach group. All of the patients underwent esophagectomy and there were no mortalities during surgery. All patients completed the follow-up period. The rates of recurrence or metastasis 1 and 2 years after surgery in the gastric tube group were observed to be lower than those in the whole stomach group. The two-year survival rates of the gastric tube group and whole stomach group were 80 and 61%, respectively. There was a significant difference in the survival rate between the two groups (P=0.016). In conclusion, this study suggests that esophageal cancer patients may gain a mid-term benefit from gastric tube reconstruction.
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Affiliation(s)
- Runqi Zhang
- Department of Thorax Surgery, Taian Central Hospital, Taian, Shandong 271000, P.R. China
| | - Peng Wang
- Department of Thorax Surgery, Taian Central Hospital, Taian, Shandong 271000, P.R. China
| | - Xiaoyan Zhang
- Department of Thorax Surgery, Taian Central Hospital, Taian, Shandong 271000, P.R. China
| | - Lei Zhang
- Department of Thorax Surgery, Taian Central Hospital, Taian, Shandong 271000, P.R. China
| | - Chao Li
- Department of Thorax Surgery, Taian Central Hospital, Taian, Shandong 271000, P.R. China
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Kitagawa H, Namikawa T, Munekage M, Akimori T, Kobayashi M, Hanazaki K. Visualization of the Stomach's Arterial Networks During Esophageal Surgery Using the HyperEye Medical System. Anticancer Res 2015; 35:6201-5. [PMID: 26504051 DOI: pmid/26504051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM The present study investigated the visualization of the arterial networks in the stomach (ANS) during gastric tube (GT) creation using indocyanine green fluorescence and the HyperEye Medical System (HEMS), and the feasibility of the HEMS-line-marking method (LMM). PATIENTS AND METHODS We reviewed 51 consecutive patients who had undergone esophageal surgery with GT reconstruction. Patients for whom the HEMS was deployed after GT creation to confirm the anastomosed area's blood supply formed the control group (n=28). Patients for whom the HEMS was deployed before GT creation to confirm and mark the ANS border comprised the HEMS-LMM group (n=23). RESULTS The HEMS-LMM visualized the ANS border, and the leakage rate decreased from 17.9% to 4.4% (p=0.204). CONCLUSION The HEMS-LMM is safe and feasible for visualizing the blood supply border of the right gastroepiploic artery and the ANS before GT creation during esophageal surgery, and it might reduce leakage in esophageal surgery.
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Affiliation(s)
| | - Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Japan
| | - Toyokazu Akimori
- Department of Surgery, Kochi Hata Prefectural Hospital, Yamanacho, Sukumo, Kochi, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Nankoku, Kochi, Japan
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Zhang M, Wu QC, Li Q, Jiang YJ, Zhang C, Chen D. Comparison of the health-related quality of life in patients with narrow gastric tube and whole stomach reconstruction after oncologic esophagectomy: a prospective randomized study. Scand J Surg 2014; 102:77-82. [PMID: 23820680 DOI: 10.1177/1457496913482234] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS To compare the health-related quality of life in patients with narrow gastric tube and whole stomach reconstructions after oncologic esophagectomy. MATERIAL AND METHODS In a prospective randomized single-center study from 2007 to 2008, 104 patients underwent esophagectomy for cancer. To assess health-related quality of life, the questionnaire (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the Oesophagus-Specific Quality of Life Questionnaire 18) was administered at 3 weeks, 6 months, 1 year, and 2 years after surgery. RESULTS The perioperative complication rate was 26.9% in narrow gastric tube group and 48.1% in whole stomach group (P = 0.31). At the time of 3 weeks after surgery, the reflux and dyspnea scores were higher in whole stomach group than in narrow gastric tube group, which meant that the patients in whole stomach group suffered more severe problem. At the time of 6 months and 1 year after surgery, the reflux scores were lower in narrow gastric tube group than in whole stomach group, which revealed that there were less problems of reflux in the patients of narrow gastric tube group; meanwhile, the score of physical function scale in narrow gastric tube group was higher conversely, which suggested that the patients gain a better status in physical function. Nausea and vomiting is the only notable symptom that was worse in whole stomach group at the time of 2 years after surgery, which suggested that patients in whole stomach group suffered more severe nausea and vomiting. CONCLUSIONS Narrow gastric tube reconstruction may be a good alternative choice for patients undergoing oncologic esophagectomy in view of better health-related quality of life after the surgery.
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Affiliation(s)
- M Zhang
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Mochiki E, Fukuchi M, Ogata K, Ohno T, Ishida H, Kuwano H. Postoperative functional evaluation of gastric tube after laparoscopic proximal gastrectomy for gastric cancer. Anticancer Res 2014; 32:940. [PMID: 25075061 DOI: 10.1016/j.urolonc.2014.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 05/23/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND The primary aim of this study was to examine the motor activity (motility) of a gastric tube after laparoscopic-assisted proximal gastrectomy (LPG). A secondary objective was to ascertain whether a correlation exists between gastric tube motor activity and reflux esophagitis. PATIENTS AND METHODS A total of 41 patients who underwent LPG for early gastric cancer were studied. The motility of the gastric tube and the status of reflux esophagitis were evaluated. Manometric recording was performed 2 weeks and 1 year after surgery. RESULTS In a fasting state, the motilities of the distal gastric tube and duodenum recovered within 1 year after surgery but that of the proximal gastric tube did not recover. Improvement of the motility of the gastric tube was associated with a decreased number of patients with reflux esophagitis 1 year after surgery. In patients with reflux esophagitis, the motility of the distal gastric tube was significantly lower than that in patients without reflux esophagitis. CONCLUSION After LPG, the motility of the gastric tube recovered, and the incidence of reflux esophagitis decreased with time, in parallel to recovery of gastrointestinal motility.
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Affiliation(s)
- Erito Mochiki
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan
| | - Minoru Fukuchi
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan
| | - Kyouichi Ogata
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan
| | - Tetsuro Ohno
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan
| | - Hideyuki Ishida
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan
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