Blind nasogastric tube advancement following
Background: 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 surgeons 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. Nasogastric
tube advancement followed by endoscopy with water submersion 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 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. No injuries were identified to the gastric conduit staple line. Intermittent catching or
curling at the anastomosis occasionally occurred but never resulted in injury. Leak test with
endoscopic insufflation was negative. Sixty-seven post-esophagectomy patients at a single
institution between January 2013 and December 2015 were included in the second phase of
our study. Anastomotic leak occurred in four (6%) patients. No gastric leaks, and no 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.