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Fluoroscopically guided three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage.

Yin G, Xu Q, Chen S, Bai X, Jiang F, Zhang Q, Xu L, Xu W - Korean J Radiol (2012)

Bottom Line: The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%).The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 ± 0.40 g/dL) to post-enteral feeding (3.7 ± 0.51 g/dL) via the feeding tube (p < 0.001).Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Radiology, Cancer Institution of Jiangsu Province, Nanjing, China.

ABSTRACT

Objective: To retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL).

Materials and methods: From January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients' nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube.

Results: The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 ± 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 ± 0.40 g/dL) to post-enteral feeding (3.7 ± 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months).

Conclusion: Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary procedure to treat postoperative GEAL.

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Drain tube (arrow 1) inserted through fistula with fluoroscopic guidance and distal tip of drain tube was positioned at bottom of abscess cavity (arrow 4).Feeding nasojejunum tube (arrow 2) and cases of nasogastric decompression tube (arrow 3) were placed during interventional operation for postoperative enteral nutrition supply and digestive slice drainage.
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Figure 2: Drain tube (arrow 1) inserted through fistula with fluoroscopic guidance and distal tip of drain tube was positioned at bottom of abscess cavity (arrow 4).Feeding nasojejunum tube (arrow 2) and cases of nasogastric decompression tube (arrow 3) were placed during interventional operation for postoperative enteral nutrition supply and digestive slice drainage.

Mentions: The study population included 28 patients suffering from postoperative GEAL and underwent three-tube insertion under fluoroscopic guidance from January 2007 to January 2011. The 28 patients underwent an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma. The 28 patients consisted of 18 males and 10 females ranging in age from 36 to 72 years (mean age: 59 years). Three of the patients were TNM stage I esophageal carcinoma patients, nine were TNM stage II a, eleven were TNM stage II b, and five were TNM stage III. A frozen-section analysis of resected margins by a competent pathologist was available, and resection margins were found to be cancer-free in all cases. The retrospective study was approved by the Institutional Review Board of our hospital and the Ethics Committee of the Institute for Medical Science. The procedure was explained to all of the patients in detail, and a written consent was obtained from all patients prior to the procedure. The patients were divided into two groups: one group contained the patients with leakage within 14 postoperative days, and the other group patients with leakage at more than 14 postoperative days (22). Twenty of the 28 patients experienced acute leakages, and 8 patients had chronic leakages. Signs and symptoms were present in all patients (100%) and included high fever in 26 patients, shortness of breath in 18 patients, chest pain in eight patients, and arrhythmia in six patients. The leakages in the 24 patients (85.7%) were confirmed by first radiographic contrast examination. Four (14.2%) patients initially had negative contrast examination results, but they were all eventually proven to have anastomotic leakage by repeated radiographic contrast examinations 3 to 7 d later. The leakage in all patients was first confirmed by a computed tomography (CT) examination (Fig. 1A). The three tubes were removed after the leak's closure was testified by CT findings.


Fluoroscopically guided three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage.

Yin G, Xu Q, Chen S, Bai X, Jiang F, Zhang Q, Xu L, Xu W - Korean J Radiol (2012)

Drain tube (arrow 1) inserted through fistula with fluoroscopic guidance and distal tip of drain tube was positioned at bottom of abscess cavity (arrow 4).Feeding nasojejunum tube (arrow 2) and cases of nasogastric decompression tube (arrow 3) were placed during interventional operation for postoperative enteral nutrition supply and digestive slice drainage.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3303901&req=5

Figure 2: Drain tube (arrow 1) inserted through fistula with fluoroscopic guidance and distal tip of drain tube was positioned at bottom of abscess cavity (arrow 4).Feeding nasojejunum tube (arrow 2) and cases of nasogastric decompression tube (arrow 3) were placed during interventional operation for postoperative enteral nutrition supply and digestive slice drainage.
Mentions: The study population included 28 patients suffering from postoperative GEAL and underwent three-tube insertion under fluoroscopic guidance from January 2007 to January 2011. The 28 patients underwent an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma. The 28 patients consisted of 18 males and 10 females ranging in age from 36 to 72 years (mean age: 59 years). Three of the patients were TNM stage I esophageal carcinoma patients, nine were TNM stage II a, eleven were TNM stage II b, and five were TNM stage III. A frozen-section analysis of resected margins by a competent pathologist was available, and resection margins were found to be cancer-free in all cases. The retrospective study was approved by the Institutional Review Board of our hospital and the Ethics Committee of the Institute for Medical Science. The procedure was explained to all of the patients in detail, and a written consent was obtained from all patients prior to the procedure. The patients were divided into two groups: one group contained the patients with leakage within 14 postoperative days, and the other group patients with leakage at more than 14 postoperative days (22). Twenty of the 28 patients experienced acute leakages, and 8 patients had chronic leakages. Signs and symptoms were present in all patients (100%) and included high fever in 26 patients, shortness of breath in 18 patients, chest pain in eight patients, and arrhythmia in six patients. The leakages in the 24 patients (85.7%) were confirmed by first radiographic contrast examination. Four (14.2%) patients initially had negative contrast examination results, but they were all eventually proven to have anastomotic leakage by repeated radiographic contrast examinations 3 to 7 d later. The leakage in all patients was first confirmed by a computed tomography (CT) examination (Fig. 1A). The three tubes were removed after the leak's closure was testified by CT findings.

Bottom Line: The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%).The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 ± 0.40 g/dL) to post-enteral feeding (3.7 ± 0.51 g/dL) via the feeding tube (p < 0.001).Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Radiology, Cancer Institution of Jiangsu Province, Nanjing, China.

ABSTRACT

Objective: To retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL).

Materials and methods: From January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients' nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube.

Results: The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 ± 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 ± 0.40 g/dL) to post-enteral feeding (3.7 ± 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months).

Conclusion: Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary procedure to treat postoperative GEAL.

Show MeSH
Related in: MedlinePlus