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. 2023 Jan;30(1):563-570.
doi: 10.1245/s10434-022-12596-9. Epub 2022 Oct 10.

Contrast-Enhanced Radiologic Evaluation of Gastric Conduit Emptying After Esophagectomy

Minke L Feenstra  1   2   3 , Lily Alkemade  1 , Janneke E van den Bergh  4 , Suzanne S Gisbertz  1   2   3 , Freek Daams  2   3   5 , Mark I van Berge Henegouwen  1   2   3 , Wietse J Eshuis  6   7   8
Affiliations

Contrast-Enhanced Radiologic Evaluation of Gastric Conduit Emptying After Esophagectomy

Minke L Feenstra et al. Ann Surg Oncol. 2023 Jan.

Abstract

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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Conflict of interest statement

Mark van Berge Henegouwen has is a consultant for Mylan, Alesi, Johnson and Johnson, Medtronic, and BBraun. All fees are paid to the institution and unrelated to current study. He also has a Stryker grant, with the fee paid to the institution and unrelated to current study. The remaining authors have no conflicts of interest.

Figures

Fig. 1
Fig. 1
In the left image, the upper gastrointestinal contrast passage evaluation (UGI-CE) shows contrast passage through the gastric conduit. In the right image, no passage is shown
See this image and copyright information in PMC

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