Korean J Radiol.  2012 Apr;13(2):182-188. 10.3348/kjr.2012.13.2.182.

Fluoroscopically Guided Three-Tube Insertion for the Treatment of Postoperative Gastroesophageal Anastomotic Leakage

• Yin G
• Xu Q
• Chen S
• Bai X
• Jiang F
• Zhang Q
• Xu L
• Xu W

• KMID: 1245382
• DOI: http://doi.org/10.3348/kjr.2012.13.2.182

Abstract

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.

Keyword

GEAL; Three-tube insertion; Interventional procedure; Esophageal and cardiac carcinoma

MeSH Terms

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

Figure

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  Fig. 1 Intrathoracic anastomotic leak testified by CT at 1 week postoperation. Fistula was located in pleural cavity (A, black arrow). Fistula closed at 25 days (B).

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  Fig. 2 Drain tube (arrow 1) inserted through fistula with fluoroscopic guidance and distal tip of drain tube was positioned at bottom of abscess cavity (arrow 4). Feeding nasojejunum tube (arrow 2) and cases of nasogastric decompression tube (arrow 3) were placed during interventional operation for postoperative enteral nutrition supply and digestive slice drainage.

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  Fig. 3 Eleven days later, fistula (arrow 1) got smaller, after changing position of drainage tube (arrow 2) to keep optimum drainage.

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  Fig. 4 Fistula closed on 25 days. Nasojejunum enteral supports tube (arrow 1) was retained for enteral nutrition.

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