Blind Nasogastric Tube Advancement Following Esophagectomy
Mohammed Mustafa, Erin Harris, Thomas Fabian.
Albany Medical College, Albany, NY, USA.
OBJECTIVE: 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 providers 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. An NGT was blindly advanced to 40 cm and 60 cm, 50 times each. Endoscopy 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 67 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. In the post-esophagectomy patients, anastomotic leak occurred in four (6%) patients. No gastric leaks or 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.
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