Blind nasogastric tube advancement following esophagectomy
- Gastroenterology & Hepatology: Open Access
Erin S Harris, Thomas Fabian
Background: Esophagectomy remains the primary curative treatment for esophageal cancer. Postoperatively, surgeons routinely drain the gastric conduit with a nasogastric tube (NGT). This tube is removed after the anastomosis is thought to have healed. Occasionally, patients require replacement of the NGT. Many surgeons are hesitant to place an NGT blindly due to perceived risk of harm to the anastomosis or gastric conduit. Our investigation was carried out to clarify whether the concern of blind NGT placement is justified.
Methods: In phase one, a porcine model of an Ivor-Lewis esophagectomy with a stapled end to side anastomosis was constructed and placed within a thorax model. Nasogastric tube advancement followed by endoscopy with water submersion was conducted to assess for damage or anastomotic leak. The second phase assessed clinical outcomes of minimally invasive Ivor-Lewis esophagectomy with mechanical end to side anastomosis in patients who underwent blind NGT placement at the conclusion of their procedure.
Results: No mucosal injuries, anastomotic leaks or perforations were observed in the model. No injuries were identified to the gastric conduit staple line. Intermittent catching or curling at the anastomosis occasionally occurred but never resulted in injury. Leak test with endoscopic insufflation was negative. Sixty-seven post-esophagectomy patients at a single institution between January 2013 and December 2015 were included in the second phase of our study. Anastomotic leak occurred in four (6%) patients. No gastric leaks, and no gastric tip necrosis occurred. One (1.5%) mortality occurred.
Conclusions: Blind NGT placement did not harm the gastric staple line or cause mucosal injury in the esophagectomy model. No significant anastomotic leaks or gastric conduit leaks were identified in the clinical series. Blind NGT placement following stapled end to side intrathoracic anastomosis is safe and appropriate following esophagectomy.
esophagectomy, anastamotic leak, nasogastric tube, NGT, Ivor-Lewis, NGT, nasogastric tube, NIH, national institutes of health, SCC, squamous cell carcinoma, TEF, tracheoesophageal fistula