PS01.037: APPLYING THORACIC ENDOVASCULAR AORTIC REPAIR (TEVAR) AND SURGICAL RESECTION WITH RECONSTRUCTION OF ESOPHAGUS IN MANAGING OF AORTA-ESOPHAGEAL FISTULA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 60-60
Author(s):  
Yi-Pin Chou ◽  
Hsing-Lin Lin
Keyword(s):  
Hemorrhagic Shock ◽  
Esophageal Perforation ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Oral Intake ◽  
Acute Stage ◽  
Esophageal Stent ◽  
Thoracic Esophagus ◽  
Esophageal Fistula ◽  
Subtotal Esophagectomy

Abstract Background Aorta-esophageal fistula (AEF) is very dangerous with high mortality. Treatment is difficult because of hemorrhagic shock in acute stage and infection in sub-acute stage. We develop a method to manage both perforations from aorta and esophagus successfully. Methods A 56 male patient had fish bone incarcerated in thoracic esophagus. Two months after this accident, intermittent massive hematemesis occurred. The esophagoscopy displayed active bleeding and AEF was diagnosed by computed tomography angiography (CTA). TEVAR is applied immediately and stopped bleeding successfully. Fever with sepsis and mediastinitis was happened after oral intake. The perforated esophagus was removed by wire-stripper through neck and abdomen incisions and reconstructed with gastric tube via retro-sternal route. Results After subtotal esophagectomy with gastric tube reconstruction, the ventilator is weaned and endotracheal tube was removed. No leakage from anastomosis between cervical esophagus and gastric tube. Patient could swallow regular diet smoothly. No further post-operative complication was happened after follow up two years. Conclusion TEVAR is the first step in managing AEF in acute stage to prevent hemorrhagic shock. Although esophageal perforation could be managed with esophageal stent, the marginal ulcer with pain and bleeding may cause other side effects. Esophageal stent is also another contra-indication applied in benign disease. Subtotal esophagectomy with wire-stripper and reconstruction with gastric tube could provide definite treatment for this esophageal perforation. Disclosure All authors have declared no conflicts of interest.

PS01.174: AN EXAMINATION OF OUTCOMES AFTER ANTE-THORACIC ROUTE WITH RIGHT HEMICOLON RECONSTRUCTION AFTER ESOPHAGECTOMY.

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 99-99
Author(s):  
Yuki Hirata ◽  
Hirofumi Kawakubo ◽  
Shuhei Mayanagi ◽  
Kazumasa Fukuda ◽  
Rieko Nakamura ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Average Duration ◽  
Oral Intake ◽  
Recurrent Nerve ◽  
Nerve Paralysis ◽  
Recurrent Nerve Paralysis ◽  
Reconstruction Group ◽  
Group 1

Abstract Background In our institute, we usually use gastric tube for reconstruction organ after esophagectomy. When we can’t use gastric tube, we use right hemi-colon with ante-thoracic route. Previously, we reconstructed by 1-step after esophagectomy, but from 2012, we have done by 2-step for reduce postoperative complications. Methods We enrolled 15 esophageal cancer patients who underwent esophagectomy and right hemicolon reconstruction between April 2004 and December 2016. Results The average age of 15 patients is 67.3. The reasons of using right hemicolon are as follows; post gastrectomy 13, stomach double cancer 2. The reasons of gastrectomy are as follows; gastric cancer 8, duodenum cancer 1, gastric ulcer 4. The average duration from gastrectomy to esophagectomy is 12.5 year. We reconstructed by 1-step for 5 patients, and after 2012, we reconstructed by 2-step for 10 patients. Anastomotic leakages were found in 2 cases (40.0%) in 1-step reconstruction group, and 3 cases (20.0%) in 2-step reconstruction group. In 1-step reconstruction group, 1 case occurred multiple anastomotic leakages and DIC, and another 1 case was found necrosis of reconstructive colon. In 2-step reconstruction group, we found 1 case of major leakage and 1 case of recurrent nerve paralysis and 2 cases of postoperative pneumonia. However, there were no case of tracheotomy. The incidence of pneumonia did not differ between the two groups. And the term of postoperative oral intake tend to shorter in 2-step reconstruction group (P = 0.06). 2 severe postoperative complications (Clavian-Dindo V or IVa) cases were found in 1-step reconstruction group, on the other hand, 2 cases severe complications (CD IIIa) in 2-step reconstruction group. Conclusion In the case of using right hemicolon as a reconstructive organ, 2-step reconstruction approach is useful and superior from the viewpoints of postoperative complications. Disclosure All authors have declared no conflicts of interest.

PS01.089: A DIFFERENT FIXATION METHOD TO PREVENT STENT MIGRATION IN ESOPHAGEAL FISTULAS AND PERFORATIONS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 75-75
Author(s):  
Atila Eroglu ◽  
Yener Aydin ◽  
Ali Ulas ◽  
Omer Yilmaz
Keyword(s):  
Esophageal Perforation ◽  
Suture Material ◽  
Conflicts Of Interest ◽  
Flexible Endoscopy ◽  
Stent Migration ◽  
Suture Technique ◽  
Esophageal Stent ◽  
Fixation Method ◽  
High Morbidity ◽  
Delivery Catheter

Abstract Background Esophageal perforation is an emergency condition characterized by high morbidity and mortality. The removable esophageal stent is an effective method of treatment in cases with esophageal perforation as they allow minimal invasive and rapid nutrition. Stent migration is an important problem in perforations and fistulas where there is no obstruction in the esophageal lumen. Several methods are used to prevent stent migration, including different stent types and endoscopic suture technique. In this study, we aimed to present a method that we use in our clinic to prevent stent migration. Methods We retrospectively evaluated 12 consecutive patients who underwent stent placement and were fixed for migration prevention for esophageal fistula or perforation between January 2013 and February 2018 in our clinic. All of the cases were self-expandable metallic stents. The stent was removed from the delivery catheter without insertion and the suture material was passed through the head and reattached to the catheter. The stent was placed using flexible endoscopy. The suture material placed on the upper part of the stent was taken out of the mouth of the patient. After the stent is inserted and the delivery catheter is removed, the nasal catheter (aspiration catheter) was inserted and removed from the mouth. The suture material in the mouth was connected to the tip of the aspiration catheter. The aspiration catheter was withdrawn. The suture material removed from the patient's nose was fixed like a nasogastric catheter. After 3 or 4 days from the procedure, the suture was cut. Migration of the stent was followed by direct radiography. Results Seven cases were female and five cases were male. The mean age was 51.1 ± 12.7 years (range 20–72 years). No migrations were observed in any of the cases. After a mean of 19.5 days (range 11–23 days), the stent was removed endoscopically. In all cases, perforation and fistula improved. Conclusion We think that the esophageal stent fixation method is a simple and effective method to prevent migration. 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.

PS01.198: THERAPEUTIC STRATEGY FOR ONCOLOGIC EMERGENCY IN ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 106-106
Author(s):  
Junki Fujita ◽  
Hiroto Muroi ◽  
Masanobu Nakajima ◽  
Satoru Yamaguchi ◽  
Kinro Sasaki
Keyword(s):  
Esophageal Cancer ◽  
Bypass Surgery ◽  
Conflicts Of Interest ◽  
Salvage Surgery ◽  
Oral Intake ◽  
Esophageal Stent ◽  
University Hospital ◽  
Advanced Esophageal Cancer ◽  
Oncologic Emergency ◽  
Surgery Group

Abstract Background Oncologic emergency in esophageal cancer are classified into bleeding, fistula and stenosis. The esophageal cancer infiltrating surrounding organs is inoperable. Although chemoradiotherapy is often used to cure advanced esophageal cancer with invasion to other organs, the prognosis is generally poor. In this study, we investigated and assessed the outcomes of esophageal stent, bypass surgery and salvage surgery in advanced esophageal cancer with aortic invasion, combined with aortic stent-graft. Methods 24 patients who received esophageal stent, 6 patients who received bypass surgery and 4 patients who underwent salvage surgery at the Dokkyo Medical University Hospital between April 2009 and December 2016 were reviewed retrospectively. Results The esophageal stent was performed for stenosis in 15 cases, airway fistula in 4 cases, lung fistula in 4 cases and mediastinal fistula in 1 case. Although oral intake improved in 21/24 cases (87.5%), all stenosis cases achieved to gain oral intake. On the other hand, the bypass surgery group achieved to gain oral intake in all cases. The days required to start oral intake in the stent group were significantly shorter than that of the bypass group (P < 0.05). The same results was obtained in the hospitalization (P < 0.05). In the salvage surgery group, the average operative duration was 580 min (range, 307–825 min), the average blood loss was 543ml (range, 194–914ml) and the average hospitalization was 32days (range, 15–47days). There were no postoperative complications and all cases have been achieved pathological complete response. Conclusion Even for advanced esophageal cancer needed intervention immediately, we always have investigate the curability of cancer with secured safety. Disclosure All authors have declared no conflicts of interest.

PS01.168: IS IT POSSIBLE TO PREVENT GASTRIC TUBE NECROSIS FOLLOWING ESOPHAGECTOMY?

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 97-97
Author(s):  
Katsunori Nishikawa ◽  
Yujiro Tanaka ◽  
Yuichiro Tanishima ◽  
Shunsuke Akimoto ◽  
Fumiaki Yano ◽  
...  
Keyword(s):  
Gastric Tube ◽  
Assessment Tool ◽  
Imaging System ◽  
Conflicts Of Interest ◽  
Tissue Perfusion ◽  
Early Postoperative Period ◽  
Partial Replacement ◽  
Full Thickness ◽  
Intraoperative Assessment ◽  
Vascular Insufficiency

Abstract Background Gastric tube necrosis (GN) following esophagectomy is a rare, but critical and life threatening complication. Unlike anastomotic leakage due to local ischemia, GN involves extensive full thickness ischemia resulting from vascular insufficiency. Most cases of GN need total or partial replacement of gastric tube. Although quantitative assessment of tissue perfusion during esophageal surgery contributed to reduce the incidence of postoperative anastomotic complications, GN remains a serious complication to be solved. Methods Data were collected retrospectively from 271 patients who underwent esophagectomy and gastric tube reconstruction at a single center between 2008 and 2018, in which cases of GN were identified. Gastric mobilization was mainly performed laparoscopically using a hand-assisted maneuver. The short gastric and left gastric arteries were divided, and the right gastric and gastroepiploic arteries were both preserved. The gastric tube 3.5 cm in width was created along the greater curvature. Intraoperative assessment of perfusion of the gastric tube was performed using our novel Thermal Imaging System (TIS) in all patients. Quantitative tissue perfusion scores defined as anastomotic viability index (AVI) were calculated at various points from the anastomosis. Results The inpatient mortality rate was 1.8% (n = 5). Anastomotic leak (AL) developed in 8.8% (n = 24) of the study group. The mean AVI score of cases with AL was 0.58, which was significantly lower than that without AL (0.71, P < 0.001). GN occurred in two patients (0.7%). The AVI score of the both GN cases were relatively high at 0.74 and 0.82. In one of the cases, circumferential full thickness ischemia 10 cm in length from the esophagogastric anastomosis was revealed by contrast CT scans and endoscopy, which was later identified to be due to severe vascular impairment. Conclusion TIS can be used as a reliable intraoperative assessment tool for perfusion of the gastric tube. We assume that most AL would be caused by delayed anastomotic healing due to poor vascularization of the gastric tube. On the other hand, obvious difference in AVI scores between AL and GN may indicate the involvement of different etiology. Given that development of GN seemed to be caused by acute failure in vascularization during the early postoperative period. Disclosure All authors have declared no conflicts of interest.

scholarly journals Successful management of atrio-esophageal fistula using a fully covered esophageal stent case report

2021 ◽  
Vol 0 ◽  
pp. 0-0
Author(s):  
Daisy Sanchez ◽  
Francisco Tarrazzi ◽  
Scott Harter ◽  
Mark Block ◽  
Syed S. Razi
Keyword(s):  
Case Report ◽  
Esophageal Stent ◽  
Esophageal Fistula ◽  
Successful Management

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

scholarly journals Evaluation of anatomical and functional changes esophageal stump of patients with advanced megaesophagus submitted to subtotal laparoscopic esophagectomy

2012 ◽  
Vol 27 (9) ◽  
pp. 650-658 ◽  
Author(s):  
Júverson Alves Terra Júnior ◽  
Guilherme Azevedo Terra ◽  
Alex Augusto da Silva ◽  
Eduardo Crema
Keyword(s):  
Gastric Tube ◽  
Gastric Fundus ◽  
Endoscopic Examination ◽  
Average Height ◽  
Functional Changes ◽  
Subtotal Esophagectomy ◽  
Laparoscopic Esophagectomy ◽  
Pathological Evaluation ◽  
Gastric Reflux ◽  
Cervical Level

PURPOSE: Evaluate anatomical and functional changes of the esophageal stump and gastric fundus of patients with advanced megaesophagus, submitted to laparoscopic subtotal esophagectomy. METHODS: Twenty patients with advanced megaesophagus, previously submitted to a videolaparoscopic subtotal esophagectomy , were evaluated. Were conducted: radiological evaluation of the stump esophagus with transposed stomach, electromanometric, endoscopic examination and histopathology of the esophageal stump and gastric fundus, without making gastric tube or pyloroplasty. RESULTS: It was observed that the average height and pressure of the anastomosis, in the electromanometric evaluation, were 23.45cm (±1.84cm) and 7.55mmHg (±5.65mmHg). In patients with megaesophagus III, the pressure of the anastomosis was 10.91mmHg (±6.33mmHg), and pressure from the UES, 31.89mmHg (±14.64mm Hg), were significantly higher than those in grade IV. The pathological evaluation detected mild esophagitis in 35% of patients, moderate in 20% and acanthosis glicogenica in 45%. The examination of the gastric fundus showed that 50% of patients were infected with Helicobacter pylori. Chronic gastritis occurred in 95% of the patients. CONCLUSIONS: The laparoscopic esophagectomy shown to be effective in the treatment of advanced achalasia. The cervical level anastomosis protects the esophageal stump from the aggression resulted from gastric reflux after the esophagectomy.

PS02.204: GASTRIC TUBE CANCER AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A SYSTEMATIC REVIEW

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 180-180
Author(s):  
Damiano Gentile ◽  
Pietro Riva ◽  
Anna Da Roit ◽  
Silvia Basato ◽  
Salvatore Marano ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Case Reports ◽  
Treatment Strategies ◽  
Vocal Cord Palsy ◽  
Review Literature ◽  
Gastric Tube Cancer ◽  
Publication Number

Abstract Background Gastric conduit used for reconstruction after esophagectomy for esophageal cancer (EC) has the potential to develop a metachronous cancer known as gastric tube cancer (GTC). The aim of our study was to review literature and evaluate outcomes and possible treatment strategies for GTC. Methods A comprehensive systematic literature search was conducted using PubMed. No restriction was set for type of publication, number, age and sex of patients. Study language was limited to English. Characteristics of EC and its treatment and GTC and its treatment were analyzed. Results A total of 26 studies were analyzed, 10 retrospective analysis and 16 case reports, involving 170 patients, 17 patients (10%) were affected by multifocal GTC. 143 ECs (84,1%) were squamous cell carcinomas. In 95 patients (55,9%) a posterior-mediastinal reconstructive route was used at the time of esophagectomy for EC. Mean interval between esophagectomy and diagnosis of GTC was 67,18 months (4–236 months). 184 GTCs were metachronous lesions (98,4%). 164 GTCs were adenocarcinomas (98,2%). 84 GTCs were located in the lower part of the gastric tube. 88 patients were endoscopically treated. 63 patients underwent surgery. 30 total gastrectomies + limphoadenectomy with colon or jejunal interposition were performed. 27 subtotal gastrectomies and 6 wedge resections were performed. Main reported post-operative complications were: anastomotic leak, vocal cord palsy and respiratory failure. 19 patients were treated with chemoradiotherapy and palliative care. 68,2% of endoscopically treated patients, 63,5% of surgically resected patients and 5,2% of patients who underwent chemoradiotherapy were alive at a mean follow-up of 25,5 months. Feasibility of endoscopic resections in patients diagnosed with superficial GTC has been established. Surgical treatment represents the preferred treatment modality in operable patients with locally invasive tumor. Patients treated with conservative therapy have a scarce prognosis. Conclusion Yearly endoscopic follow-up is of paramount importance in patients who underwent esophagectomy for EC with gastric tube reconstruction. At least, a 10-year endoscopic surveillance is recommended. Disclosure All authors have declared no conflicts of interest.

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