Percutaneous Transesophageal Gastro-tubing for Management of Gastric Leakage After Sleeve Gastrectomy

Oshiro, Takashi; Saiki, Atsuhito; Suzuki, Jun-Ichi; Satoh, Ayami; Kitahara, Tomoaki; Kadoya, Kengo; Moriyama, Ayako; Ooshiro, Mitsuru; Nagashima, Makoto; Park, Youngjin; Okazumi, Shinichi; Katoh, Ryoji

doi:10.1007/s11695-014-1322-y

Cited by 13 publications

(8 citation statements)

References 11 publications

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“…Long-term use of an NGT causes poor patient tolerability and complications, including epistaxis, aspiration pneumonia, and sinusitis. Oshiro et al have reported PTEG for the management of gastric leakage after sleeve gastrectomy [24]. For patients who underwent bariatric surgery, it is challenging to re-operate for anastomotic leakage because of the patients' risk, i.e., they are highly obese and therefore have many preoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous transesophageal gastro-tubing for the management of anastomotic leakage after upper GI surgery: a report of two clinical cases

et al. 2020

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Background: Anastomotic leakage is a serious, sometimes critical complication of upper gastrointestinal (GI) surgery. The cavity and target drainage tubes are difficult to reach; therefore, a nasogastric tube (NGT) and fasting are required for an extended period. We successfully treated and managed two patients with anastomotic leakage using percutaneous transesophageal gastro-tubing (PTEG). Case presentation: In case 1, a 79-year-old man with gastric cancer underwent total gastrectomy; 1 week later, he underwent emergent open laparotomy due to panperitonitis attributed to anastomotic leakage-related jejunojejunostomy. We resected the portion between esophagojejunostomy and jejunojejunostomy and reconstructed it using the Roux-en-Y technique. On postoperative day (POD) 9, anastomotic leakage was diagnosed at the esophagojejunostomy site and jejunotomy staple line. After using a circular stapler for jejunojejunostomy, a stapled jejunal closure was added. We inserted an NGT and performed aspiration for bowel decompression. As he did not improve within 2 weeks, we decided to perform PTEG to free him of the NGT. We kept performing intermittent aspiration; leakage stopped shortly after, due to effective inner drainage. The PTEG catheter was removed after oral intake was restarted. In case 2, an 81-year-old man with esophagogastric junction cancer underwent resection of the distal esophagus and proximal stomach. After shaping the remnant stomach, esophagogastrostomy was performed under the right thoracotomy. On POD 11, anastomotic leakage was identified, along with a mediastinal abscess. We inserted an NGT into the abscess cavity through the anastomotic leakage site. On POD 25, we performed PTEG and inserted a drainage tube, instead of an NGT. Although the abscess cavity disappeared, anastomotic leakage persisted as a fistula. We exchanged the PTEG with a double elementary diet (W-ED) tube with jejunal extension, with the side hole located near the anastomosis. The anastomotic fistula disappeared after treatment. Dysphagia persisted due to disuse atrophy of swallowing musculature; PTEG was useful for enteral feeding, even after the leakage occurred. Conclusion: Patients are sometimes forced to endure pain for a long time for transnasal inner drainage. Using PTEG, patients will be free of sinus pain and discomfort; PTEG should be helpful for patients withstanding NGT.

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Section: Discussionmentioning

confidence: 99%

Percutaneous transesophageal gastro-tubing for the management of anastomotic leakage after upper GI surgery: a report of two clinical cases

et al. 2020

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“…In our center, all of the leaks from all sleeve cases in the past 8 years, whether performed at our center or outside centers and then transferred to our care, occurred in the proximal 4 cm or less of the sleeve. A high percentage of the published cases occur at this location [5–8]. Contributing factors include tissue ischemia, elevated intraluminal pressures, host impaired healing, and suboptimal closure techniques including poor stapler height choice, staple malformation, or hematoma formation.…”

Section: Discussionmentioning

confidence: 99%

Technical Details of Laparoscopic Sleeve Gastrectomy Leading to Lowered Leak Rate: Discussion of 1070 Consecutive Cases

Warner

Sasse

2017

Minimally Invasive Surgery

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Introduction Laparoscopic sleeve gastrectomy is a widely utilized and effective surgical procedure for dramatic weight loss in obese patients. Leak at the sleeve staple line is the most serious complication of this procedure, occurring in 1–3% of cases. Techniques to minimize the risk of sleeve gastrectomy leaks have been published although no universally agreed upon set of techniques exists. This report describes a single-surgeon experience with an approach to sleeve leak prevention resulting in a progressive decrease in leak rate over 5 years. Methods 1070 consecutive sleeve gastrectomy cases between 2012 and 2016 were reviewed retrospectively. Patient characteristics, sleeve leaks, and percent body weight loss at 6 months were reported for each year. Conceptual and technical changes aimed towards leak reduction are presented. Results With the implementation of the described techniques of the sleeve gastrectomy, the rate of sleeve leaks fell from 4% in 2012 to 0% in 2015 and 2016 without a significant change in weight loss, as depicted by 6-month change in body weight and percent excess BMI lost. Conclusion In this single-surgeon experience, sleeve gastrectomy leak rate has fallen to 0% since the implementation of specific technical modifications in the procedure.

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“…Small-bowel tubing via the PTEG route is a feasible procedure to relieve nasal discomfort. 13,14 Post-esophagectomy Generally, PTEG is not indicated after esophagectomy because percutaneous gastrojejunostomy is technically feasible. 15 However, percutaneous gastrojejunostomy is also technically difficult for subtotal esophagectomy with a gastric tube reconstruction of the posterior mediastinal route.…”

Section: Gastrointestinal Tubing Via the Percutaneous Transesophageal Gastrotubing Routementioning

confidence: 99%

Techniques for percutaneous transesophageal gastrotubing

Sato

Chatani

Hasegawa

et al. 2021

Int J Gastrointest Interv

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Percutaneous transesophageal gastrotubing (PTEG) procedure was developed in Japan as an alternative access route into the gastrointestinal tract, and it has been performed for patients in whom percutaneous endoscopic gastrostomy would be technically difficult to place or is contraindicated, such as in a prior gastrectomy and massive ascites. In the PTEG procedure, an indwelling tube is inserted through the cervical esophagus, which gives the patient a slight discomfort after the tube placement. Therefore, PTEG is performed not only for enteral feeding, but also for bowel decompression as a palliative care in patients with malignant gastrointestinal obstruction. Recently, several reports of PTEG from countries outside Japan indicated a high technical success rate without major complications. Furthermore, the usefulness of PTEG for bowel decompression as a palliative care was reported in prospective studies. In fact, PTEG is a technically feasible and safe procedure worldwide.

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Percutaneous Transesophageal Gastro-tubing for Management of Gastric Leakage After Sleeve Gastrectomy

Cited by 13 publications

References 11 publications

Percutaneous transesophageal gastro-tubing for the management of anastomotic leakage after upper GI surgery: a report of two clinical cases

Percutaneous transesophageal gastro-tubing for the management of anastomotic leakage after upper GI surgery: a report of two clinical cases

Technical Details of Laparoscopic Sleeve Gastrectomy Leading to Lowered Leak Rate: Discussion of 1070 Consecutive Cases

Techniques for percutaneous transesophageal gastrotubing

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