Nasogastric Placement of Sump Tube Through the Leak for the Treatment of Esophagogastric Anastomotic Leak After Esophagectomy for Esophageal Carcinoma

Jiang, Feng; Yu, Ming Feng; Ren, Bin Hui; Guo, Yin; Zhang, Qin; Xu, Lin

doi:10.1016/j.jss.2010.07.005

Cited by 16 publications

(33 citation statements)

References 15 publications

(23 reference statements)

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“…Use of the current suturing device for this application in order to reduce stent migration is not formally approved in the FDA clearance. Although our small series showed no esophago-aortic fistulas, after review of the published literature 16 17 18 19 20 21, there is a well-recognized risk for this complication. Improved stent management may be able to reduce this risk and will require more formal study which may examine stent sizes, length of dwell time, stent free periods, and stent exchange.…”

Section: Discussionmentioning

confidence: 53%

Utility of endoscopic therapy in the management of Boerhaave syndrome

et al. 2016

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Background/aims: The optimal intervention for Boerhaave perforation has not been determined. Options include surgical repair with/without a pedicled muscle flap, T tube placement, esophageal resection or diversion, or an endoscopic approach. All management strategies require adequate drainage and nutritional support. Our aim was to evaluate outcomes following Boerhaave perforation treated with surgery, endoscopic therapy, or both. Patients and methods: We performed a 10-year review of our prospectively maintained databases of adult patients with Boerhaave perforations. We documented clinical presentation, extent of injury, primary intervention, “salvage” treatment (any treatment for persistent leak), and outcome. Results were analyzed using the Fisher’s exact and Kruskal – Wallis tests. Results: Between October 2004 and October 2014, 235 patients presented with esophageal leak/fistula with 17 Boerhaave perforations. Median age was 68 years. Median length of perforation was 1.25 cm (range 0.8 – 5 cm). Four patients presented with systemic sepsis (two treated with palliative stent and two surgically). Primary endotherapy was performed for eight (50 %) and primary surgery for eight (50 %) patients. Two endotherapy patients required multiple stents. Median stent duration was 61 days (range 56 – 76). “Salvage” intervention was required in 2/8 (25 %) endotherapy patients and 1/8 (13 %) surgery patient (stent). All patients healed without resection/reconstruction. There were no deaths in the surgically treated group and two in the endotherapy group (stented with palliative intent due to poor systemic condition). Readmission within 30 days occurred in 3/6 of alive endotherapy patients (50 %) and 0/8 surgery patients. Re-intervention within 30 days was required for one endotherapy patient. Conclusion: Endoscopic repair of Boerhaave perforations can be useful in carefully selected patients without evidence of systemic sepsis. Endoscopic therapy such as stenting is particularly valuable as a “salvage” intervention. The benefits of endoscopic therapy and esophageal preservation are offset against an increased risk of readmission in patients primarily treated endoscopically.

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Section: Discussionmentioning

confidence: 53%

Utility of endoscopic therapy in the management of Boerhaave syndrome

et al. 2016

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“…In our opinion the key in management is adequate and effective drainage. Previous studies have revealed that most of the mediastinal abscesses were in contained leaks [18][19][20]. It is difficult to deal with this type of abscess by the conventional chest tube.…”

Section: Discussionmentioning

confidence: 99%

Fluoroscopically guided nose tube drainage of mediastinal abscesses in post-operative gastro-oesophageal anastomotic leakage

Guo²,

Chen³

et al. 2012

The British Journal of Radiology

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Objective The aim of this study was to retrospectively evaluate the technical success rates and clinical effectiveness of fluoroscopically guided nose tube drainage of mediastinal abscesses and a nasojejunum feeding tube in post-operative gastro-oesophageal anastomotic leakage (GEAL). Methods From January 2006 to June 2011, 18 cases of post-operative GEAL with mediastinal abscesses after oesophagectomy with intrathoracic oesophagogastric anastomotic procedures for oesophageal and cardiac carcinoma were treated by insertion of a nose drainage tube and nasojejunum feeding tube under fluoroscopic guidance. We evaluated the feasibility of two-tube insertion to facilitate leakage site closure and complete resolution of the abscess, and the patients’ nutritional benefit was also evaluated by checking the serum albumin level between pre- and post-enteral feeding via the feeding tube. Results The two tubes were placed successfully under fluoroscopic guidance in 18 patients (100%). The procedure time for two-tube insertion ranged from 20 to 40 min (mean 30 min). 17 patients (94%) achieved leakage site closure after two-tube insertion and had a good tolerance of two tubes in the nasal cavity. The serum albumin level was significant, increased from pre-enteral feeding (2.49±0.42 g dl−1) to the post-enteral feeding (3.58±0.47 g dl−1) via the feeding tube (p<0.001). The duration of follow-up ranged from 1 to 49 months (mean 19 months). Conclusion The insertion of nose tube drainage and a nasojejunum feeding tube under fluoroscopic guidance is safe, and it provides effective relief from mediastinal abscesses in GEAL after oesophagectomy. Moreover, our findings indicate that two-tube insertion may be used as a selective procedure to treat mediastinal abscesses in post-operative GEAL. Advances in knowledge Directive drainage of mediastinal abscesses in post-operative GEAL may be an effective treatment.

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“…This technique appears to be an effective, technically feasible, and minimally invasive treatment option for intrathoracic esophagogastric anastomotic leak [13]. We performed trans-nasal drainage at the site of intrathoracic esophagogastric anastomotic leak.…”

Section: Thoracic Drainage Inserted Through Trans-nasal Routementioning

confidence: 99%