論文

査読有り 国際誌
2020年3月5日

Simplified percutaneous endoscopic transgastric conduit feeding jejunostomy for dysphagia after esophagectomy.

Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
  • Osamu Shiraishi
  • ,
  • Hiroaki Kato
  • ,
  • Mituru Iwama
  • ,
  • Yoko Hiraki
  • ,
  • Atsushi Yasuda
  • ,
  • Ying-Feng Peng
  • ,
  • Masayuki Shinkai
  • ,
  • Yutaka Kimura
  • ,
  • Motohiro Imano
  • ,
  • Takushi Yasuda

33
2
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1093/dote/doz042

Unexpected dysphagia is an important problem affecting life prognosis in patients who have undergone an esophagectomy for esophageal cancer. For nutritional support in patients suffering from dysphagia after a previous esophagectomy, a simplified percutaneous endoscopic transgastric conduit feeding jejunostomy approach was developed that can be performed regardless of the patient's condition. The feasibility of this procedure in 25 patients with esophageal cancer who underwent three-stage esophagectomy with retrosternal gastric conduit reconstruction from April 2009 to December 2016 was evaluated retrospectively. Under fluoroscopy, a percutaneous endoscopic transgastric conduit feeding jejunostomy catheter (9 French) was introduced into the jejunum in the epigastric region using the Seldinger's technique. The following patient data were analyzed retrospectively: operating time, complications, reasons for oral intake difficulty, and clinical data describing patients' nutritional status before and 1 month after percutaneous endoscopic transgastric conduit jejunostomy treatment, such as serum albumin and clinical course. Median patients' age was 68 years (range 50-76 years). Indications for the procedure were late swallowing dysfunction (n = 12), early swallowing dysfunction secondary to surgical complication (n = 8), anastomotic leakage (n = 3), and anorexia (n = 2). Causes of late swallowing dysfunction were radiation injury (n = 8), advanced age (n = 2), or cerebral infarction (n = 2). The median operating time was 29 minutes (range 14-82 minutes). Four patients developed mild erosions at the stoma secondary to bile reflux along the side of the catheter. No patient experienced severe complications such as ileus and peritonitis. Patients were treated for a median of 160 days (range 18-3106 days) with percutaneous endoscopic transgastric conduit jejunostomy. Patient's serum albumin significantly increased from 2.8 to 3.3 g/dl in 1 month. Of the eight patients with early swallowing dysfunction, six successfully regained sufficient oral nutrition after receiving enteral feeding nutritional management. Although all except one late swallowing dysfunction patient could not discontinue tube feeding, five patients were long-term survivors at the time this report was written. This jejunostomy procedure is simple, safe, and useful for patients with unexpected dysphagia and accompanying malnutrition after esophagectomy.

リンク情報
DOI
https://doi.org/10.1093/dote/doz042
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/31069391
ID情報
  • DOI : 10.1093/dote/doz042
  • ISSN : 1120-8694
  • PubMed ID : 31069391

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