Baseball bat-like gastric tube for end-to-side oesophageal-gastric anastomosis decreased risks of anastomotic leakage after oesophagectomy for oesophageal cancer: A retrospective propensity score matched comparative study with 613 patients

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.

Download Full-text

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

Journal of Thoracic Disease ◽

10.21037/jtd.2016.12.62 ◽

2016 ◽

Vol 8 (12) ◽

pp. 3551-3562 ◽

Cited By ~ 13

Author(s):

Liang Zhao ◽

Gefei Zhao ◽

Jiagen Li ◽

Bin Qu ◽

Susheng Shi ◽

...

Keyword(s):

Anastomotic Leakage ◽

Gastric Tube ◽

Cervical Anastomosis

Download Full-text

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

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.148 ◽

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.

Download Full-text

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

Esophagus ◽

10.1007/s10388-019-00705-9 ◽

2019 ◽

Vol 17 (3) ◽

pp. 264-269 ◽

Cited By ~ 1

Author(s):

Seiya Inoue ◽

Takahiro Yoshida ◽

Takeshi Nishino ◽

Masakazu Goto ◽

Yoshihito Furukita ◽

...

Keyword(s):

Anastomotic Leakage ◽

Gastric Tube ◽

Gastric Tube Reconstruction

Download Full-text

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

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.186 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 102-103 ◽

Cited By ~ 1

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.

Download Full-text