Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 4/2022

07-02-2022 | Esophageal Cancer | Original Article

Double tract-like gastric tube reconstruction decreases the incidences of delayed gastric emptying and bile reflux after esophagectomy: results of a pilot study of an experimental technique

Authors: Daisuke Fujimoto, Keizo Taniguchi, Junpei Takashima, Fumihiko Miura, Hirotoshi Kobayashi

Published in: Langenbeck's Archives of Surgery | Issue 4/2022

Login to get access

Abstract

Purpose

Esophagectomy with gastric tube reconstruction is often complicated postoperatively by duodenogastric reflux and/or delayed gastric emptying and the accompanying symptoms, leading to patients being dissatisfied with their quality of life (QOL). Medical interventions to relieve patients of their symptoms are rarely effective. We began, in 2018, performing double tract-like gastric tube reconstruction, and, in a pilot study, we compared postoperative QOL between patients in whom this experimental reconstruction was performed and those in whom conventional reconstruction was performed.

Methods

Included in the study were 33 patients who underwent thoracoscopic McKeown esophagectomy with two- or three-field lymph node dissection for thoracic esophageal cancer between April 2015 and March 2020. A gastric tube about 4 cm in width was created in all patients, and in 14 of the patients (DT group), a double tract was appended by anastomosing the elevated jejunum to the anterior wall of the gastric tube, QOL was assessed 10–14 months later by means of the DAUGS-32 questionnaire, and bile reflux and the presence or absence of food residue were assessed by upper gastrointestinal endoscopy.

Results

DAUGS-32 food passage dysfunction, nausea and vomiting, and reflux symptoms scores were significantly lower in the DT group than in the conventional reconstruction group. There was no significant between-group difference in the incidence of postoperative complications. No food residue was seen in DT patients’ gastric tube, and no reflux esophagitis was observed.

Conclusion

Double tract-like gastric tube reconstruction shows promise as an effective means of improving patients’ post-esophagectomy QOL.
Appendix
Available only for authorised users
Literature
1.
Watanabe M, Otake R, Kozuki R et al (2020) Recent progress in multidisciplinary treatment for patients with esophageal cancer. Surg Today 50:12–20PubMedCrossRef
2.
3.
Isono K, Sato H, Nakayama K (1991) Results of a nationwide study on the three-field lymph node dissection of esophageal cancer. Oncol 48:411–420CrossRef
4.
Elliott JA, Docherty NG, Eckhardt HG et al (2017) Weight loss, satiety, and the postprandial gut hormone response after esophagectomy: a prospective study. Ann Surg 266:82–90PubMedCrossRef
5.
Takeuchi H, Miyata H, Gotoh M et al (2014) A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg 260:259–266PubMedCrossRef
6.
Harada K, Yoshida N, Baba Y et al (2017) Pyloroplasty may reduce weight loss 1 year after esophagectomy. Dis Esophagus 31:1–8
7.
8.
Shirahata K, Okabayashi T, Nagaoka K, Shiratori T (1971) Effect of vagotomy on the antral motor function. Nihon Heikatsukin Gakkai Zasshi 7:28–34PubMedCrossRef
9.
10.
11.
Wilbur BG, Kelly KA (1973) Effect of proximal gastric, complete gastric, and truncal vagotomy of canine gastric electric activity, motility, and emptying. Ann Surg 178:295–303PubMedPubMedCentralCrossRef
12.
Ukegiini K, Vetter D, Fehr R, Dirr V, Gubler C, Gutschow CA (2021) Functional syndromes and symptom-orientated aftercare after esophagectomy. Langenbecks Arch Surg 406:2249–2261CrossRef
13.
Ludwig DJ, Thirlby RC, Low DE (2001) A prospective evaluation of dietary status and symptoms after near-total esophagectomy without gastric emptying procedure. Am J Surg 181:454–458PubMedCrossRef
14.
Palmes D, Weilinghoff M, Colombo-Beckmann M, Senninger N, Bruewer M (2007) Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction. Langenbecks Arch Surg 392:135–141PubMedCrossRef
15.
Demos NJ, Kulkarni VA, Port A, Micale J (1993) Control of postresection gastroesophageal reflux: the intercostal pedicle esophagogastropexy experience of 26 years. Ann Surg 59:137–148
16.
Ahn SH, Jung DH, Son SY, Lee CM, Park DJ, Kim HH (2014) Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer. Gastric Cancer 17:562–570PubMedCrossRef
17.
Kitagawa Y, Uno T, Oyama T et al (2019) Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society. Esophagus 16:1–24PubMedCrossRef
18.
Kitagawa Y, Uno T, Oyama T et al (2019) Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 2. Esophagus 16:25–43PubMedCrossRef
19.
Nakamura M, Kido Y, Yano M, Hosoya Y (2005) Reliability and validity of a new scale to assess postoperative dysfunction after resection of upper gastrointestinal carcinoma. Surg Today 35:535–542PubMedCrossRef
20.
Yano M, Sugimura K, Miyata H et al (2020) Randomized comparison of gastric tube reconstruction with and without duodenal diversion plus Roux-en-Y anastomosis after esophagectomy. Ann Surg 272:48–54PubMedCrossRef
21.
Armstrong D, Bennett JR, Blum AL et al (1996) The endoscopic assessment of esophagitis: a progress report on observe agreement. Gastroenterol 111:85–92CrossRef
22.
Fukuhara K, Osugi H, Lee S, Morimura K, Kishida S, Nishizawa S, Iwasaki H, Gyobu K (2009) Remnant gastritis should be evaluated histologically rather than endoscopically. Hepatogastroentrol 56:905–907
23.
Konradsson M, van Berge Henegouwen MI, Bruns C et al (2020) Diagnostic criteria and symptom grading for delayed gastric conduit emptying after esophagectomy for cancer: international expert consensus based on a modified Delphi process. Dis Esophagus 33:1–9CrossRef
24.
Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196PubMedCrossRef
25.
Standring S, Borley NR, Gray H (2008) Gray’s anatomy: the anatomical basis of clinical practice. Churchill Livingstone, London
26.
Cheung HC, Siu KF, Wong J (1987) Is pyloroplasty necessary in esophageal replacement by stomach? A prospective, randomized controlled trial. Surgery 102:19–24PubMed
27.
Gupta S, Chattopadhyay TK, Gopinath PG (1989) Emptying of the intrathoracic stomach with and without pyloroplasty. Am J Gastroenterol 84:921–923PubMed
28.
Law S, Cheung MC, Fok M (1997) Pyloroplasty and pyloromyotomy in gastric replacement of the esophagus after esophagectomy: a randomized controlled trial. J Am Coll Surg 184:630–636PubMed
29.
Arya S, Markar SR, Karthikesalingam A, Hanna GB (2015) The impact of pyloric drainage on clinical outcome following esophagectomy: a systematic review. Dis Esophagus 28:326–335PubMedCrossRef
30.
Ohwada S, Satoh Y, Kawate S et al (2001) Low-dose erythromycin reduces delayed gastric emptying and improves gastric motility after Billroth I pylorus-preserving pancreaticoduodenectomy. Ann Surg 234:668–674PubMedPubMedCentralCrossRef
31.
Gutschow CA, Collard JM, Romagnoli R, Michel JM, Salizzoni M, Holscher AH (2001) Bile exposure of the denervated stomach as an esophageal substitute. Ann Thorac Surg 71:1786–1791PubMedCrossRef
32.
Dresner SM, Wayman J, Bennet MK, Hayes N, Griffin SM (2003) A human model of duodeno-gastro-esophageal reflux in the development of Barrett’s metaplasia. Br J Surg 90:1120–1128PubMedCrossRef
33.
Watkins D, Prevedel A, Harper F (1954) A method of preventing peptic esophagitis following esophagogastrostomy. J Thorac Surg 28:367–381PubMedCrossRef
34.
35.
Yalav E, Ercan S (2000) Reservoir and globe-type antireflux surgical techniques in intrathoracic esophagogastrostomies. Dis Esoph 13:282–287CrossRef
36.
Lortat-Jacob J, Maillard J, Fekete F (1960) A procedure to prevent reflux after esophagogastric resection: experience with 17 patients. Surgery 50:600–611
37.
Yano M, Motoori M, Tanaka K et al (2012) Prevention of gastroduodenal content reflux and delayed gastric emptying after esophagectomy: gastric tube reconstruction with duodenal diversion plus Roux-en-Y anastomosis. Dis Esophagus 25:181–187PubMedCrossRef
38.
Arnold M, Laversanne M, Brown LM, Devesa SS, Bray F (2017) Predicting the future burden of esophageal cancer by histological subtype: international trends in incidence up to 2030. Am J Gastroenterol 112:1247–1255PubMedCrossRef
39.
Berry MF, Atkins BZ, Tong BC, Harpole DH, D’Amico TA, Onaitis MW (2010) A comprehensive evaluation for aspiration after esophagectomy reduces the incidence of postoperative pneumonia. J Thorac Cardiovasc Surg 140:1266–1271PubMedPubMedCentralCrossRef
40.
Satake K, Nishiwaki H, Umeyama K (1985) Comparative studies of plasma secretin response after reconstructive surgery of the stomach and pancreas. Ann Surg 201:447–451PubMedCrossRef
41.
Okada G, Momoki C, Habu D et al (2019) Effect of postoperative oral intake on prognosis for esophageal cancer. Nutrients 11:1338CrossRef
42.
Zhang H, Shang X, Ren P et al (2019) The predictive value of a preoperative systemic immune-inflammation index and prognostic nutritional index in patients with esophageal squamous cell carcinoma. J Cell Physiol 234:1794–1802PubMedCrossRef
43.
Kalmar K, Németh J, Kelemen D, Agoston E, Horvath OP (2006) Postprandial gastrointestinal hormone production is different, depending on the type of reconstruction following total gastrectomy. Ann Surg 243:465–471PubMedPubMedCentralCrossRef
44.
Nakajima K, Kawano M, Kinami S, Fujimura T, Miwa K, Tonami N (2005) Dual-radionuclide simultaneous gastric emptying and bile transit after gastric surgery with double-tract reconstruction. Ann Nucl Med 19:185–191PubMedCrossRef
Metadata
Title
Double tract-like gastric tube reconstruction decreases the incidences of delayed gastric emptying and bile reflux after esophagectomy: results of a pilot study of an experimental technique
Authors
Daisuke Fujimoto
Keizo Taniguchi
Junpei Takashima
Fumihiko Miura
Hirotoshi Kobayashi
Publication date
07-02-2022
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 4/2022
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-022-02461-4

Other articles of this Issue 4/2022

Langenbeck's Archives of Surgery 4/2022 Go to the issue

Original Article

Outcomes of patients with ischemic colitis causing severe hematochezia managed medically or surgically

Original Article

Predictors for stone recurrence after a successful common bile duct surgical exploration for choledocholithiasis

Original Article

Robotic-assisted minimally invasive Ivor Lewis esophagectomy within the prospective multicenter German da Vinci Xi registry trial

Original Article

Predictive value of postoperative day 1 parathyroid hormone levels for early and late hypocalcaemia after thyroidectomy

How-I-Do-It articles

Total robotic choledochal cyst excision with Roux-en-Y hepaticojejunostomy in adults

Original Article

Infectious outcomes after splenectomy for trauma, splenectomy for disease and splenectomy with distal pancreatectomy