Minke L Feenstra1,2,3, Lily Alkemade1, Janneke E van den Bergh4, Suzanne S Gisbertz1,2,3, Freek Daams2,3,5, Mark I van Berge Henegouwen1,2,3, Wietse J Eshuis6,7,8. 1. Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands. 2. Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands. 3. Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands. 4. Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. 5. Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. 6. Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands. w.j.eshuis@amsterdamumc.nl. 7. Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands. w.j.eshuis@amsterdamumc.nl. 8. Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands. w.j.eshuis@amsterdamumc.nl.
Abstract
BACKGROUND: Nasogastric tube (NGT) insertion is the standard of care in many hospitals after esophagectomy for gastric conduit decompression. An upper gastrointestinal contrast passage evaluation (UGI-CE) is a diagnostic test to evaluate passage through the gastric conduit. The authors hypothesized that introducing routine UGI-CE after esophagectomy results in earlier removal of the NGT and resumption of oral intake. METHODS: This retrospective study evaluated two consecutive series of patients undergoing esophagectomy, one before (control group) and one after the introduction of a routine UGI-CE on postoperative day (POD) 3 or 4 (UGI-CE group). If contrast passage was found on the UGI-CE, the NGT was capped and removed. In the control group, the NGT was routinely capped and removed on day 5 after surgery. The primary outcome was the POD on which oral diet was initiated. The secondary outcomes were the day of NGT removal, NGT reinsertions, postoperative complications, and length of hospital stay. RESULTS: Each cohort included 74 patients. In the UGI-CE group, the contrast test was performed on median POD 3.5 (IQR, 3-4). The median day of NGT removal, initiation of clear liquids, and full liquid and solid intake was 1 to 2 days earlier in the UGI-CE group than in the control group (i.e. POD 4, 4, 5, and 6 vs. POD 5, 5, 6.5, and 8; all p < 0.001). The study found no significant differences in NGT reinsertions, pneumonias, anastomotic leakages, or hospital stay. CONCLUSION: The routine use of a UGI-CE after esophagectomy led to earlier removal of the NGT and earlier resumption of oral intake.
BACKGROUND: Nasogastric tube (NGT) insertion is the standard of care in many hospitals after esophagectomy for gastric conduit decompression. An upper gastrointestinal contrast passage evaluation (UGI-CE) is a diagnostic test to evaluate passage through the gastric conduit. The authors hypothesized that introducing routine UGI-CE after esophagectomy results in earlier removal of the NGT and resumption of oral intake. METHODS: This retrospective study evaluated two consecutive series of patients undergoing esophagectomy, one before (control group) and one after the introduction of a routine UGI-CE on postoperative day (POD) 3 or 4 (UGI-CE group). If contrast passage was found on the UGI-CE, the NGT was capped and removed. In the control group, the NGT was routinely capped and removed on day 5 after surgery. The primary outcome was the POD on which oral diet was initiated. The secondary outcomes were the day of NGT removal, NGT reinsertions, postoperative complications, and length of hospital stay. RESULTS: Each cohort included 74 patients. In the UGI-CE group, the contrast test was performed on median POD 3.5 (IQR, 3-4). The median day of NGT removal, initiation of clear liquids, and full liquid and solid intake was 1 to 2 days earlier in the UGI-CE group than in the control group (i.e. POD 4, 4, 5, and 6 vs. POD 5, 5, 6.5, and 8; all p < 0.001). The study found no significant differences in NGT reinsertions, pneumonias, anastomotic leakages, or hospital stay. CONCLUSION: The routine use of a UGI-CE after esophagectomy led to earlier removal of the NGT and earlier resumption of oral intake.
Authors: Kelly R Haisley; Missy L DeSouza; Elizabeth N Dewey; Sabrina E Drexel; Yalini Vigneswaran; John G Hunter; James P Dolan Journal: JAMA Surg Date: 2019-09-01 Impact factor: 14.766
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Authors: Frans van Workum; Moniek H P Verstegen; Bastiaan R Klarenbeek; Stefan A W Bouwense; Mark I van Berge Henegouwen; Freek Daams; Suzanne S Gisbertz; Gerjon Hannink; Jan Willem Haveman; Joos Heisterkamp; Walther Jansen; Ewout A Kouwenhoven; Jan J B van Lanschot; Grard A P Nieuwenhuijzen; Donald L van der Peet; Fatih Polat; Sander Ubels; Bas P L Wijnhoven; Maroeska M Rovers; Camiel Rosman Journal: JAMA Surg Date: 2021-07-01 Impact factor: 14.766