OBJECTIVE: To establish a modified endoscopic Freka Trelumina placement (mEFTP) for modifying or substituting the traditional endoscopic Freka Trelumina placement (EFTP) and to explore the safety and feasibility of mEFTP in patients requiring enteral nutrition and gastrointestinal decompression in general surgery. METHODS: A retrospective cohort study was conducted to analyze the clinical data of patients undergoing EFTP or mEFTP at General Surgery Department of 920 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January 2016 to January 2018. INCLUSION CRITERIA: the function of lower digestive tract was normal; patients who could not eat through mouth or nasogastric tube needed to have enteral nutrition and gastrointestinal decompression; the retention time of Freka Trelumina (FT) was not expected to exceed 2 months. EXCLUSION CRITERIA: contraindication for gastroscopy; suspected shock or digestive tract perforation; suspected mental diseases; infectious diseases of digestive tract; thoracoabdominal aortic aneurysm. mEFIP procedure was as follow. FT was inserted into stomach through one side nasal cavity, gastroscope was inserted into stomach cavity, and the front part of FT was clamped with biopsy forceps through biopsy hole. Biopsy forceps and FT were inserted into the pylorus or anastomosis under gastroscope, and they were pushed into the duodenum or output loop. During pushing, the gastroscope did not pass through the duodenum or output loop. The biopsy forceps was released and pushed out, and FT was pushed with biopsy forceps synchronously into the duodenum or output loop more than 5 cm. The foreign body forceps was inserted through the biopsy hole, and the FT tube was held in the stomach and pushed to the duodenum or output loop. The previous steps repeated until the suction cavity reached the pylorus or anastomosis. The gastroscope was exited gently; the guide wire was pulled out slowly. EFTP procedure: foreign body forceps was used to clamp the front part of FT, and gastroscope, foreign body forceps and FT pass the pylorus or anastomosis simultaneously to reach the descendent duodenum or output loop as a whole. The time of catheterization was recorded and position of FT was examined by X-ray within 1 h after catheterization. The success rate of catheterization and morbidity of complications after catheterization were evaluated and compared between the two groups. RESULTS: A total of 141 patients were enrolled, 72 in the mEFTP group and 69 in the EFTP group. In mEFTP group, 45 cases were males and 27 were females with an average age of 55.8(37-76) years; 27 cases had normal upper gastrointestinal anatomy (postoperative gastroplegia syndrome due to colon cancer in 17 cases, due to rectal cancer in 10 cases) and 45 had upper gastrointestinal anatomic changes (gastric cancer with pylorus obstruction in 18 cases and anastomotic block after gastroenterostomy in 27 cases). In the EFTP group, 41 were males and 28 were females with an average age of 55.3(36-79) years; 33 cases had normal upper gastrointestinal anatomy (postoperative gastroplegia syndrome due to colon cancer in 20 cases, due to rectal cancer in 13 cases) and 36 had upper gastrointestinal anatomic changes (gastric cancer with pylorus obstruction in 15 cases and anastomotic block after gastroenterostomy in 21 cases). In patients with normal upper digestive tract anatomy, the average catheterization time of mEFTP was (4.9±1.7) minutes which was shorter than (7.6±1.7) minutes of EFTP(t=6.683, P<0.001). In patients of gastric cancer with pyloric obstruction, the average catheterization time of mEFTP was (6.6±1.6) minutes which was shorter than (10.5±2.6) minutes of EFTP (t=4.724, P<0.001). In patients with anastomotic block after gastroenterostomy, the average catheterization time of mEFTP was (11.3±2.5) minutes which was shorter than (15.1±3.5) minutes of EFTP (t=4.513, P<0.001). In patients with normal upper gastrointestinal anatomy, there were no significant differences in the success rate of catheterization and the morbidity of catheterization complication between mEFTP and EFTP (all P>0.05). In patients with upper gastrointestinal anatomic changes, the success rate of catheterization in mEFTP was even higher than that in EFTP, but the difference was not significant [97.8%(41/45) vs. 86.1%(31/36), χ²=2.880, P=0.089]; while the morbidity of catheterization complication in mEFTP was lower than that in EFTP [0 vs. 8.3%(3/36), χ²=3.894, P=0.048]. CONCLUSIONS Whether the upper gastrointestinal anatomy is normal or not, mEFTP presents shorter catheterization time, higher success catheterization rate than EFTP, and is safety. mEFTP can be widely applied to clinical practice for patients requiring enteral nutrition and gastrointestinal decompression.
Adult ; Aged ; Decompression, Surgical ; instrumentation ; methods ; Enteral Nutrition ; instrumentation ; methods ; Female ; Gastric Outlet Obstruction ; etiology ; surgery ; Gastroparesis ; etiology ; surgery ; Gastroscopy ; instrumentation ; methods ; Humans ; Intubation, Gastrointestinal ; instrumentation ; methods ; Male ; Middle Aged ; Retrospective Studies ; Stomach Diseases ; etiology ; surgery

Enteral Nutrition ; instrumentation ; methods ; Female ; Fluoroscopy ; methods ; Gastrostomy ; adverse effects ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Postoperative Complications ; classification ; diagnosis ; therapy ; Reproducibility of Results ; Retrospective Studies ; Singapore ; Surgery, Computer-Assisted ; methods ; Treatment Outcome

Endoscopy plays an important role in the diagnosis and treatment of postoperative complications of gastric cancer. Endoscopic intervention can avoid the second operation and has attracted wide attention. Early gastric anastomotic bleeding after gastrectomy is the most common. With the development of technology, emergency endoscopy and endoscopic hemostasis provide a new treatment approach. According to the specific circumstances, endoscopists can choose metal clamp to stop bleeding, electrocoagulation hemostasis, local injection of epinephrine or sclerotherapy agents, and spraying specific hemostatic agents. Anastomotic fistula is a serious postoperative complication. In addition to endoscopically placing the small intestine nutrition tube for early enteral nutrition support treatment, endoscopic treatment, including stent, metal clip, OTSC, and Over-stitch suture system, can be chosen to close fistula. For anastomotic obstruction or stricture, endoscopic balloon or probe expansion and stent placement can be chosen. For esophageal anastomotic intractable obstruction after gastroesophageal surgery, radial incision of obstruction by the hook knife or IT knife, a new method named ERI, is a good choice. Bile leakage caused by bile duct injury can be treated by placing the stent or nasal bile duct. In addition, endoscopic methods are widely used as follows: abdominal abscess can be treated by the direct intervention under endoscopy; adhesive ileus can be treated by placing the catheter under the guidance of endoscopy to attract pressure; alkaline reflux gastritis can be rapidly diagnosed by endoscopy; gastric outlet obstruction mainly caused by cancer recurrence can be relieved by metal stent placement and the combination of endoscopy and X-ray can increase success rate; pyloric dysfunction and spasm caused by the vagus nerve injury during proximal gastrectomy can be treated by endoscopic pyloromyotomy, a new method named G-POEM, and the short-term outcomes are significant. Endoscopic submucosal dissection (ESD) allows complete resection of residual gastric precancerous lesions, however it should be performed by the experienced endoscopists.
Anastomosis, Surgical ; adverse effects ; Bile Ducts ; injuries ; Constriction, Pathologic ; etiology ; therapy ; Digestive System Fistula ; etiology ; therapy ; Duodenogastric Reflux ; diagnostic imaging ; etiology ; Endoscopy, Gastrointestinal ; methods ; Enteral Nutrition ; instrumentation ; methods ; Female ; Gastrectomy ; adverse effects ; Gastric Outlet Obstruction ; surgery ; Gastritis ; diagnosis ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Hemostasis, Endoscopic ; methods ; Hemostatics ; administration & dosage ; therapeutic use ; Humans ; Male ; Neoplasm Recurrence, Local ; surgery ; Postoperative Complications ; diagnosis ; therapy ; Precancerous Conditions ; surgery ; Pylorus ; innervation ; physiopathology ; surgery ; Stents ; Stomach Neoplasms ; complications ; surgery ; Treatment Outcome ; Vagus Nerve Injuries ; etiology ; surgery

Enhanced recovery after surgery (ERAS) has been rapidly developing by combining several techniques with evidence-based adjustments, including preoperative education, preoperative carbohydrate loading, epidural or regional anesthesia, early initiation of enteral nutrition, ambulation and multi-modal pain management. The core part of ERAS is to reduce and reverse surgical stress and therefore greatly improve clinical outcome. Under the guidance of ERAS, perioperative management of robotic gastric cancer operation should follow the basic principles of ERAS and clinical pathway to maximize the advantages of the robotic surgery. ERAS protocol is safe and feasible for patients undergoing robotic radical gastrectomy and it can reduce surgical stress, shorten hospital stay, improve quality of life and does not increase complications, whose mechanism may be associated with the reduction of inflammation and insulin resistance, the decrease of resting energy exposure, and the protection of mitochondria function. It is worth emphasizing that it is very important to fully understand the changes of pathophysiology during perioperative period, to strictly implement the ERAS pathway based on optimized evidence-based medicine, to cooperate closely with the multidisciplinary team, to observe and manage the postoperative complications dynamically by systemic classification. The improvement of ERAS program on the outcome of patients should be summarized regularly and the new interventional strategies should be evaluated further according to the international standard.
Anesthesia, Epidural ; Anesthesia, Local ; Convalescence ; Critical Pathways ; Enteral Nutrition ; Gastrectomy ; instrumentation ; methods ; rehabilitation ; Humans ; Length of Stay ; Pain Management ; Patient Education as Topic ; Postoperative Care ; methods ; standards ; Postoperative Complications ; prevention & control ; Preoperative Care ; Quality of Life ; Recovery of Function ; Robotic Surgical Procedures ; rehabilitation ; Stomach Neoplasms ; surgery

At present, the existing problem in nasal feeding perfusion apparatus is laborious and instability. Designing the rolling type perfusion apparatus by using a roller pump, the problem is solved. Compared with the traditional perfusion apparatus, the advantage lies in liquid carrying only need once and simulating human swallowing process. Through testing and verification, the apparatus can be used in nasal feeding perfusion for elderly or patients.
Aged ; Enteral Nutrition ; instrumentation ; Humans ; Nose ; Surgical Tape

We presented two interesting cases of gastrocolocutaneous fistula that occurred after percutaneous endoscopic gastrostomy (PEG) tube placement, and its management. This fistula is a rare complication that occurs after PEG insertion, which is an epithelial connection between mucosa of the stomach, colon, and skin. The management of the fistula is controversial, ranging from conservative to surgical intervention. Endoscopists should be aware of the possibility of gastrocolocutaneous fistula after PEG insertion, and should evaluate the risk factors that may contribute to the development of gastrocolocutaneous fistula before the procedure. We reviewed complications of gastrostomy tube insertion, symptoms of gastrocolocutaneous fistula, and its risk factors.
Aged ; Cerebral Infarction/diagnosis ; Digestive System Fistula/*etiology ; Endoscopy, Gastrointestinal ; Enteral Nutrition/*adverse effects/instrumentation ; Gastrostomy ; Humans ; Male ; Middle Aged ; Nervous System Diseases/diagnosis ; Risk Factors ; Tomography, X-Ray Computed

BACKGROUND/AIMS: To determine the prevalence and time-course of t-fastener migration after gastropexy deployment. METHODS: We reviewed our procedural database for all percutaneous gastrostomy and gastrojejunostomy tube insertions performed over a 14-month period using a widely accepted t-fastener kit for gastropexy (Kimberly-Clark). Of 201 patients, 71 (41 males, 30 females; mean age, 56 years) underwent subsequent abdominal computed tomography (CT) imaging. The location and associated findings of each t-fastener were retrospectively recorded for each CT scan performed after the tube insertion. RESULTS: A total of 153 t-fasteners were deployed during 71 procedures with subsequent CT follow-up. In the short term (within 4 weeks after deployment), 5.1% of the t-fasteners had detached and were no longer present; 59.5% were intraluminal or within the gastric wall; and 35.5% were within the anterior abdominal wall musculature or subcutaneous. In the long term (>3 months), 48.6% of the t-fasteners had detached and were no longer present, 25.0% were intraluminal or within the gastric wall, and 26.4% were within the anterior abdominal wall musculature or subcutaneous. No t-fastener-related complications, such as abscesses, fluid collections, or fistulae, were identified. CONCLUSIONS: Following gastropexy for percutaneous transgastric feeding tube placement, t-fastener migration into the abdominal wall frequently occurred soon after the tube insertion. Therefore, recent t-fastener deployment does not guarantee an intact gastropexy.
Abdominal Wall/surgery ; Enteral Nutrition ; Female ; Foreign-Body Migration/complications/*epidemiology ; Gastropexy/adverse effects/*instrumentation ; Humans ; *Intubation, Gastrointestinal ; Male ; Middle Aged ; Retrospective Studies ; *Surgical Fixation Devices/adverse effects ; Time Factors

INTRODUCTIONThe exposed section of a traditional nasogastric (NG) tube can interfere with patients' social activities and thereby result in distress. This study was conducted to evaluate the feasibility and safety of a novel two-piece NG tube for patients with dysphagia.

METHODSTen patients with dysphagia were recruited between November 2011 and May 2012. Patients who were unconscious or in critical condition, had a traditional NG tube < 50 cm or > 60 cm in fixed length, or were unable to follow instructions or sign consent forms were excluded. The two-piece NG tube, which was placed in the patients for one week, comprised a removable external tube that can be joined to an internal tube via a T-connector, which was placed close to the naris. Events related to safety (e.g. nasal pressure sores, number of unplanned extubation, displacement and spontaneous migration of the NG tube, other unpredictable injuries) and effectiveness (e.g. liquid food spills, tube obstruction, perfusion rate, other adverse circumstances) were assessed daily.

RESULTSAll patients received feeding without complication using the two-piece NG tube and none experienced premature removal of the tube. No serious NG tube complications or malfunctions were observed.

CONCLUSIONThe results of this study indicate that the two-piece NG feeding tube is a feasible option for patients with dysphagia. Future improvements to the connector may help enhance its performance. A rigorous randomised controlled trial to examine the effects of the two-piece NG tube on patients' quality of life and quality of medical care is being planned.

Aged ; Aged, 80 and over ; Deglutition Disorders ; therapy ; Enteral Nutrition ; instrumentation ; methods ; Equipment Design ; Female ; Humans ; Intubation, Gastrointestinal ; adverse effects ; methods ; Male ; Middle Aged

OBJECTIVETo evaluate the feasibility and effectiveness of placement of nasojejunal feeding tube and nasojejunal nutrition feeding in children with acute pancreatitis.

METHODTwenty-two patients (of whom 13 had severe acute pancreatitis and 9 acute mild pancreatitis) who needed nutritional intervention were selected. They were from Department of Gastroenterology and Surgery during the years 2009 - 2012, and they were at high nutritional risk after STONGkid nutrition risk screening. The average age of them was 5 - 15 years (9.1 years ± 2.8 years). Assisted by endoscopy, the nasojejunal feeding tube was placed in 22 of 24 patients (in 2 cases of recurrent pancreatitis the tubes were placed again after extubation). Besides the use of regular fasting, antacids, inhibitors of trypsin secretion, and anti-infective treatment, 23 cases of all children got nasojejunal nutrition treatment as well. The outcome measures included the success rate, complications of endoscope-assisted nasojejunal tube placement. The children's tolerance and nutrition indicators (weight, blood lymphocytes count, erythrocytes count, serum albumin, serum creatinine, blood urea nitrogen) were observed before and after enteral nutrition therapy.

RESULTMalnutrition evaluation was done 24 times before treatment among 22 patients, incidence of malnutrition was 33% in 22 cases. Placement of nasojejunal tube placement was attempted for a total of 24 times and was successful on first placement in 22 cases, in two cases the placement was successful on the second placement, so the success rate of the first attempt for placement was 92%. No significant complications were observed in any of the cases. Twenty-three of 24 cases were given standardized enteral nutrition (one case was not given enteral nutrition therapy but underwent ERCP due to obstructive jaundice). Twenty-two of 23 cases could tolerate enteral nutrition well, only 1 case was unable to tolerate enteral nutrition due to the pancreas schizophrenia, paralytic ileus. The treatment of jejunal feeding success rate was 96%. The feeding duration was 2 - 74 d (27.0 d ± 18.3 d). The adverse reactions include plugging of the tube in two cases, constipation in two cases, five cases had abdominal pain, diarrhea in 2 cases, vomiting in 2 cases and 1 case of jejunum retention. No case had nasopharynx ulcers, gastrointestinal perforation, gastrointestinal bleeding, re-feeding syndrome and infection etc. Blood erythrocytes count, serum creatinine, blood urea nitrogen were not significantly changed. Twenty of 23 cases were cured, 2 cases were improved and 1 case was unchanged.

CONCLUSIONEndoscope-assisted nasojejunal tube placement for children with acute pancreatitis is safe and feasible. Nasojejunal nutrition therapy is effective for acute pancreatitis patients who are at severe nutritional risk, especially for the improvement of the nutritional status of children.

Abdominal Pain ; etiology ; Acute Disease ; Adolescent ; Child ; Child, Preschool ; Endoscopy, Gastrointestinal ; Enteral Nutrition ; adverse effects ; instrumentation ; methods ; Feasibility Studies ; Female ; Humans ; Intubation, Gastrointestinal ; adverse effects ; methods ; Jejunum ; Male ; Malnutrition ; etiology ; therapy ; Pancreatitis ; therapy ; Severity of Illness Index ; Treatment Outcome ; Vomiting ; etiology

OBJECTIVE: To retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL). MATERIALS AND METHODS: From January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients' nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube. RESULTS: The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 +/- 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 +/- 0.40 g/dL) to post-enteral feeding (3.7 +/- 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months). CONCLUSION: Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary procedure to treat postoperative GEAL.
Adult ; Aged ; Anastomosis, Surgical ; Anastomotic Leak/radiography/*therapy ; Decompression, Surgical/instrumentation ; Drainage/instrumentation ; Enteral Nutrition/instrumentation ; Esophageal Neoplasms/*surgery ; Esophagectomy ; Female ; Fluoroscopy ; Humans ; Intubation, Gastrointestinal/*methods ; Male ; Middle Aged ; Postoperative Complications/*radiography/*therapy ; Radiography, Interventional/*methods ; Retrospective Studies ; Stomach Neoplasms/*surgery