1.Clinical Experience of Enteral Feeding Catheter Placement via the Diaphragm During Esophagectomy and Gastric Tube Reconstruction via the Posterior Mediastinal Route
Masashi ZUGUCHI ; Reijiro SAITO ; Yusuke SAITO ; Kazuki FUSEGAWA ; Daisuke ISHII ; Takuro KUMAGAI ; Yasuhi KAWAHARADA ; Yosuke KUBOTA ; Yoshitaka ENOMOTO ; Katsu HIRAYAMA ; Megumi ZUGUCHI ; Ken SAITO
Journal of the Japanese Association of Rural Medicine 2021;69(5):510-515
Simultaneous creation of an enterostomy for enteral nutrition during esophagectomy has been useful in our experience, but bowel obstruction associated with intestinal fistula remains a problem. Therefore, in this study, we retrospectively reviewed 18 patients with esophageal cancer who underwent transdiaphragmatic transgastric tube enteral feeding catheter placement during gastric tube reconstruction via the mediastinal route after esophagectomy from November 2012 to March 2014. The catheter was guided from the gastric tube into the gastrointestinal tract, with the tip placed in the jejunum distal to the ligament of Treitz. From the gastric tube, the catheter was guided along the diaphragm to the anterior abdominal wall through the extraperitoneal route. No bowel obstruction associated with catheter placement has been observed in any of the patients from the time of surgery to this writing. Also, the procedure enabled jejunostomy use for more than 5 years, similar to conventional jejunostomy. We experienced 1 case of catheter deviation into the mediastinum. Overall, transgastric tube enteral feeding catheter placement for reconstruction of the posterior mediastinal gastric tube was useful for avoiding intestinal obstruction associated with jejunostomy. However, there may be a risk of catheter displacement into the mediastinum.
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