Compared With a Nasointestinal Route, Pre-operative Enteral Nutrition via a Nasogastric Tube Reduced the Incidence of Acalculous Acute Cholecystitis After Definitive Surgery for Small Intestinal Fistula

Purpose: This study aimed to investigate the difference in the efficacy of pre-operative enteral nutrition (EN) via a nasogastric tube (NGT) and pre-operative EN via a nasointestinal tube (NIT) in reducing the incidence of post-operative acalculous acute cholecystitis (AAC) after definitive surgery (DS) for small intestinal fistulas.Methods: Patients with a small intestinal fistula, who had a DS for the disease between January 2015 and March 2021, were enrolled in this study. They were divided into the NIT group and the NGT group based on the pre-operative routes of feeding they received. The clinical characteristics of the two groups were analyzed, and the incidences of post-operative AAC in the two groups were evaluated.Results: A total of 200 patients were enrolled in the study, 85 in the NGT group and 115 in the NIT group. Thirty-one patients developed post-operative AAC (8 in the NGT group and 23 in the NIT group). The incidence of post-operative AAC was 15.5%. EN via the NGT route was associated with a reduction in the incidence of post-operative AAC (adjusted HR = 0.359; 95% CI: 0.139–0.931; P = 0.035).Conclusion: Pre-operative EN via the NGT may reduce the incidence of post-operative AAC in patients who received a DS for small intestinal fistulas.

Case of successful treatment of a patient with ischemictracheoesophageal and tracheopleural fistulas after a mckeown hybrid esophagectomy

The occurrence of tracheal fistulas of ischemic genesis combined with the failure of esophagogastroanastomosis and the communication between them is a rare and formidable complication after esophagectomy with mediastinal lymphadenectomy due to its anatomical position and extensiveness. However, it is insufficiently documented in the literature, both in terms of treatment and in terms of its causes. This observation aims to demonstrate the rare cause of this complication and the atypical successful treatment. In this case, a patient with squamous cell carcinoma G2 of the middle third of the esophagus and TNM stage cT3NxM0. On the McKeown thoracoscopic-laparotomy esophagectomy intraoperatively a short arterial vessel with a diameter of about 3 mm, which passed through the paracancerous infiltration and supplied blood to the esophagus and trachea revealed. The vessel was not isolated from the infiltrate, but was clipped and crossed between the aorta and infiltrate to maintain surgery ablastic. On the 7th day after the operation the insolvency of esophagogastroanastomosis, the fistula of the trachea with mediastinum and the communication between the leak of esophagogastroanastomosis and the fistula of the trachea were diagnosed. We consider this combination as a special case of esophagogastroanastomosis fistula, complicated by the communication between the right pleural cavity and pneumothorax. According to our experience, partial leak of esophagogastroanastomosis successfully heals by secondary tension within 10–15 days against the background of cervicotomic wound drainage and feeding through a nasointestinal tube. In this case there was a leak of saliva in the mediastinum and its penetration into the lumen of the trachea and the right pleural cavity. Surgical diversion of the fistula and stenting of the trachea were considered, but not applied, as the fistula in our opinion was controlled, but the aggressive content of the gastric conduit prevented healing. The patient was on assisted lung ventilation with minimal pressure support and inflow increased oxygen fractio. For this reason, we considered the best stenting of the esophagogastroanastomosis leak area to be covered with a stent in order to stop the aggressive content of the gastric stem from entering the fistula, which led to the successful treatment of the developed severe complication. It should be noted that this method of treatment may be ineffective in patients who need pressure support during ventilation.

Cortrak feeding tube placement: interpretation agreement of the ‘GI flexure’ system versus X-ray

Background: Blind (unguided) feeding tube placement results in 0.5% of patients suffering major complications mainly due to lung misplacement detected prior to feeding. Electromagnet-guided (Cortrak) tube placement could pre-empt such complications but undetected misplacements still occur due to incorrect trace interpretation. By identifying gastrointestinal (GI) flexures from the trace, ‘the GI flexure system’, it has been proposed that tube position can be interpreted. Aims: To audit agreement between standards of interpreting tube position: the Cortrak ‘GI flexure’ system versus X-ray. Methods: In 185 primary nasointestinal tube placements tube position determined by Cortrak trace interpretation (GI flexure) was retrospectively compared with radiological position in a blinded study. Findings: Radiological and Cortrak interpretation agreed in 92.2–98.3% of placements at different GI flexures. Discrepancy mainly occurred because some radiological images were unclear or did not cover all anatomical points. Conclusion: The GI flexure method of Cortrak interpretation appears safe but would necessitate prospective radiological investigation to definitively test equivalence.

To investigate and analyze the current using situation of nasointestinal tube in emergency department of 126 general hospitals in Guangdong province

Objective To analyze the status and cognition of nasointestinal tube in emergency department of 126 general hospitals in Guangdong province. Methods The self-designed general information questionnaire for knowledge, belief and behavior was used to investigate 602 emergency nurses of 126 general hospitals. Results 1. The cognitive score of emergency nurse on nasointestinal tube showed: The score of knowledge was (8.24 + 5.02), the qualified rate was 52.2%. the score of belief was (23.82 + 5.03), and the score of behavior was (29.77 + 18.71). Multiple linear regression results showed that，The emergency nurses' cognition of nasointestinal tube was influenced by Working age, professional ranks, level, educational background and hospital grade. （P＜0.01）2.Correlation analysis showed that the scores of attitude and behavior of nurses with different educational background, professional ranks and working age were significantly different. Conclusion Emergency nurse have a low cognition of nasointestinal tube in Guangdong Province. It is necessary to study the knowledge and technology of nasointestinal tube，make standardized operating guideline and procedure, to further improve the emergency nurses'essary to study the knowledge and technology of nasointestinal tube nificantly different.

Nasointestinal tube in mechanical ventilation patients is more advantageous

ObjectiveTo assess the effects of two different nutritional mode on the occurrence of ventilator-associated pneumonia (VAP) in patients on mechanical ventilation.Methods70 patients admitted to the ICU and under mechanical ventilation, were randomly divided into the nasointestinal tube group and nasogastric tube group. Patients from both groups received enteral nutrition, using the same nutritional agent, through intubation. The duration of stay in the ICU, duration of mechanical ventilation, incidence of VAP, nutritional state, and survival of the intestinal tract were compared between the two groups.ResultsThe duration of stay in the ICU, duration of mechanical ventilation and incidence of VAP in the nasointestinal tube group was lower than that in the nasogastric tube group (P<0.05). There was an increase in the levels of prealbumin and transferrin in the nasointestinal tube group (P<0.05). However, there were no obvious difference in the nasogastric tube group (P<0.05). The incidence of abdominal distension, diarrhea, regurgitation, aspiration, and hyperglycemia in the nasointestinal tube group was much lower than that in the nasogastric tube group (P < 0.05).ConclusionThis study showed that enteral nutrition delivery using a nasointestinal way can effectively reduce the incidence of VAP and improve the nutritional status of patients under mechanical ventilation.

Effect of Preoperative Colonic Drainage for Obstructing Colorectal Cancer

Obstructing colorectal cancer (OCRC) is believed to indicate poorer long-term survival. The purpose of this study was to compare retrospectively perioperative safety and long-term results in patients undergoing surgery for OCRC following preoperative colonic decompression with that in those undergoing elective surgery alone for nonobstructing colorectal cancer (CRC). A total of 656 consecutive CRC patients undergoing colectomy between 2001 and 2011 at our institute were eligible for inclusion in the study. The patients were divided into an OCRC group, which included 104 patients undergoing colectomy with preoperative colonic decompression, and a CRC group, which included 552 patients undergoing colectomy alone. Morbidity, mortality, and prognosis were assessed. In the OCRC group, decompression was performed by nasointestinal tube in 42 patients (40.4%), transanal tube in 15 (14.4%), and colostomy in 47 (45.2%). The mortality rate was 0% in the OCRC group and 0.4% in the CRC group (2 of 552 patients). The morbidity rate was 44.8% in the OCRC group (48 of 104 patients) and 36.6% in the CRC group (202 of 552 patients). The 5-year overall survival rate was 69.5% in the OCRC group and 72.9% in the CRC group [hazard ratio 0.76; 95% confidence interval, 0.35 to 1.16; P = 0.48)]. No statistically significant difference in survival was observed between the 2 groups in stage II, III, or IV, or overall. No difference was observed in safety or survival between advanced OCRC patients undergoing preoperative colonic decompression and advanced non-obstructing CRC patients undergoing surgery alone.