ERAS guidelines-driven upper gastrointestinal contrast study after esophagectomy

Puccetti, Francesco; Klevebro, Fredrik; Kuppusamy, MadhanKumar; Hubka, M; Low, Donald E.

doi:10.1007/s00464-021-08732-3

Cited by 5 publications

(4 citation statements)

References 25 publications

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“…To our knowledge, only Puccetti et al 21 previously evaluated the use of UGI-CEs for early removal of the NGT. These authors implemented a detailed postoperative protocol with the UGI-CE on postoperative day 2 or 3.…”

Section: Discussionmentioning

confidence: 99%

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Contrast-Enhanced Radiologic Evaluation of Gastric Conduit Emptying After Esophagectomy

et al. 2022

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Background Nasogastric tube (NGT) insertion is the standard of care in many hospitals after esophagectomy for gastric conduit decompression. An upper gastrointestinal contrast passage evaluation (UGI-CE) is a diagnostic test to evaluate passage through the gastric conduit. The authors hypothesized that introducing routine UGI-CE after esophagectomy results in earlier removal of the NGT and resumption of oral intake. Methods This retrospective study evaluated two consecutive series of patients undergoing esophagectomy, one before (control group) and one after the introduction of a routine UGI-CE on postoperative day (POD) 3 or 4 (UGI-CE group). If contrast passage was found on the UGI-CE, the NGT was capped and removed. In the control group, the NGT was routinely capped and removed on day 5 after surgery. The primary outcome was the POD on which oral diet was initiated. The secondary outcomes were the day of NGT removal, NGT reinsertions, postoperative complications, and length of hospital stay. Results Each cohort included 74 patients. In the UGI-CE group, the contrast test was performed on median POD 3.5 (IQR, 3–4). The median day of NGT removal, initiation of clear liquids, and full liquid and solid intake was 1 to 2 days earlier in the UGI-CE group than in the control group (i.e. POD 4, 4, 5, and 6 vs. POD 5, 5, 6.5, and 8; all p < 0.001). The study found no significant differences in NGT reinsertions, pneumonias, anastomotic leakages, or hospital stay. Conclusion The routine use of a UGI-CE after esophagectomy led to earlier removal of the NGT and earlier resumption of oral intake.

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Section: Discussionmentioning

confidence: 99%

“…These patients were therefore already at a higher risk for a prolonged nasogastric decompression and a prolonged hospital stay. Puccetti et al 21 did not have a comparative group for which no standard UGI-CE was performed. Their study also included a limited number of patients.…”

Section: Discussionmentioning

confidence: 99%

Contrast-Enhanced Radiologic Evaluation of Gastric Conduit Emptying After Esophagectomy

et al. 2022

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“…In a recent study, 43 patients operated with esophagectomy involving gastric conduit reconstruction were prospectively examined with a UGI contrast study on postoperative days (POD) 2-3. In total, 4 (8%) patients were diagnosed with DGCE, defined as no trans-pyloric emptying at the 5-min time point (11).…”

Section: The Role Of Radiology In the Literaturementioning

confidence: 99%

Improved radiologic diagnosis of delayed gastric conduit emptying (DGCE) after esophagectomy using a functional upper gastrointestinal contrast study

Hultcrantz,

Klevebro,

Lindblad

et al. 2023

Acta Radiol

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Background With increasing incidence of esophageal cancer, a growing number of patients are at risk of developing delayed gastric conduit emptying (DGCE) in the early postoperative phase after esophagectomy. This condition is of great postoperative concern due to its association with adverse outcomes. Purpose To give a narrative review of the literature concerning radiological diagnosis of DGCE after esophagectomy and a proposal for an improved, functional protocol with objective measurements. Material and Methods The protocol was designed at Virginia Mason Medical Center in Seattle and is based on the Timed Barium Esophagogram (TBE) concept, which has been adapted to assess the passage of contrast from the gastric conduit into the duodenum. Results The literature review showed a general lack of standardization and scientific evidence behind the use of radiology to assess DGCE. We found that our proposed standardized upper gastrointestinal (UGI) contrast study considers both the time aspect in DGCE and provides morphologic information of the gastric conduit. This radiological protocol was tested on 112 patients in a trial performed at two high-volume centers for esophageal surgery and included an UGI contrast study 2–3 days postoperatively. The study demonstrated that this UGI contrast study can be included in the standardized clinical pathway after esophagectomy. Conclusion This new, proposed UGI contrast study has the potential to diagnose early postoperative DGCE in a standardized manner and to improve overall patient outcomes after esophagectomy.

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“…Nasogastric tube decompression at the time of esophageal resection is currently recommended [12].However, the timing to remove the nasogastric tubeand the need for a contrast study prior to removal is controversial.Early removal of nasogastric tube policy has not been shown to increase pulmonary complications or anastomoticleakage [35]. Moreover, a recent prospectivestudyfound thatearly nasogastric tuberemovalon post-operative day 2-3 after anupper gastrointestinal contrast studyshowing a normal conduit emptying is feasible [36].…”

Section: Focusing On Key Eras Componentsmentioning

confidence: 99%

State of the art of enhanced recovery after surgery (ERAS) protocols in esophagogastric cancer surgery: the Western experience

et al. 2022

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Enhanced recovery after surgery programs provide a framework to standardize care processes and improve outcomes. The results of this multimodal and multidisciplinary approach have been beneficial across several surgical procedures in reducing morbidity and hospital stay without increasing readmissions.The implementation of these programs in esophagogastric cancer surgery has been challenging due to the complexity of both procedures and the high risk of complications, with most of the evidence coming from the East. Despite the limited evidence for ERAS in esophageal surgery in Western centers, systematic reviews and meta-analysis have confirmed that ERAS programs reduce pulmonary complications and hospital stay after esophagectomy without increasing readmissions. Single-center Western studies have shown that implementing gastrectomy ERAS protocols resulted in a reduction of the use of nasogastric tube and intrabdominal drains, accelerated advancement of diet and reduced length of stay, without increasing complications. Despite these beneficial outcomes, it has become clear that there has been wide heterogeneity and absence of standardization in the number and definition of the ERAS components. The development of ERAS consensus guidelines including procedure-specific components may reduce this variability.Regardless of growing evidence of effectiveness, adherence to ERAS protocols in esophagogastric surgery remains challenging and had great variability with a wide adherence rate (5.6-100%) for single item.As initial experiences have demonstrated to be so beneficial, an implementation of the protocols with multidisciplinary team engagement and feedback based on periodic audits is desirable. Pre-and posthabilitation are emerging concepts that are becoming relevant for the implementation of these protocols.

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ERAS guidelines-driven upper gastrointestinal contrast study after esophagectomy

Cited by 5 publications

References 25 publications

Contrast-Enhanced Radiologic Evaluation of Gastric Conduit Emptying After Esophagectomy

Contrast-Enhanced Radiologic Evaluation of Gastric Conduit Emptying After Esophagectomy

Improved radiologic diagnosis of delayed gastric conduit emptying (DGCE) after esophagectomy using a functional upper gastrointestinal contrast study

State of the art of enhanced recovery after surgery (ERAS) protocols in esophagogastric cancer surgery: the Western experience

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