1
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Locke J, Norwood DA, Forrister N, Ahmed AM, Aryan M, Oster R, Reddy S, Kabir Baig KK, Peter S. Safety and efficacy of direct percutaneous endoscopic jejunostomy tube placement compared with surgical jejunostomy: a tertiary care analysis. Gastrointest Endosc 2024; 99:981-988.e5. [PMID: 38103750 DOI: 10.1016/j.gie.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND AND AIMS Jejunostomy tube placements provides enteral access for feeding in eligible patients who cannot meet their nutritional needs by mouth. They can be surgically placed laparoscopically (lap-J) or with the use of a conventional open laparotomy approach (open-J). Recently, direct percutaneous endoscopic jejunostomy (DPEJ) has emerged as an alternative owing to its low cost and shorter recovery times. We sought to retrospectively compare the procedural success rates and adverse events of these methods. METHODS Patients were identified by querying our health system patient database and the departmental database of patients who underwent DPEJ. The patients were divided into 3 cohorts based on the procedure: DPEJ, lap-J, or open-J. Patient age and body mass index, procedural success rate, and adverse event rate were compared among the 3 groups. RESULTS A total of 201 patients met inclusion criteria (65 DPEJ, 111 lap-J, and 25 open-J). Procedural success rates were similar among the 3 groups (DPEJ 96.9%, lap-J 99.1%, open-J 100%; P = .702). Rates of infection and bleeding were also similar among the 3 groups. There were no cases of GI perforation. Tube dysfunction for any reason that required complete removal or replacement within 90 days occurred more often in the surgical groups than in the DPEJ group (DPEJ 0%, lap-J 35.1%, open-J 40.0%; P < .001). This was driven largely by increased rates of tube clogging and tube dislodgement in the surgical groups. CONCLUSIONS DPEJ is a safe and effective alternative to surgical jejunostomy in eligible patients and may be associated with decreased adverse event rates at 90 days.
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Affiliation(s)
- John Locke
- Division of Internal Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Dalton A Norwood
- Division of Preventive Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Nicholas Forrister
- Division of Internal Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Ali M Ahmed
- Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, Alabama, USA
| | - Mahmoud Aryan
- Division of Internal Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Robert Oster
- Division of Preventive Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Sushanth Reddy
- Division of Surgical Oncology, University of Alabama, Birmingham, Alabama, USA
| | | | - Shajan Peter
- Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, Alabama, USA
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2
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Song GJ. Feasibility of laparoscopic Witzel feeding jejunostomy. JOURNAL OF MINIMALLY INVASIVE SURGERY 2023; 26:51-52. [PMID: 37347096 PMCID: PMC10280104 DOI: 10.7602/jmis.2023.26.2.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Geum Jong Song
- Department of Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Korea
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3
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Varshney P, N V, Varshney VK, Soni S, B S, Agarwal L, Swami A. Laparoscopic Witzel feeding jejunostomy: a procedure overlooked! JOURNAL OF MINIMALLY INVASIVE SURGERY 2023; 26:28-34. [PMID: 36936038 PMCID: PMC10020746 DOI: 10.7602/jmis.2023.26.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/06/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
Purpose Feeding jejunostomy (FJ) is a critical procedure to establish a source of enteral nutrition for upper gastrointestinal disorders. Minimally invasive surgery has the inherent benefit of better patient outcomes, less postoperative pain, and early discharge. This study aims to describe our total laparoscopic technique of Witzel FJ and to compare its outcome with its open counterpart. Methods A retrospective database analysis was performed in patients who underwent laparoscopic (n = 20) and open (n = 21) FJ as a stand-alone procedure from July 2018 to July 2022. A readily available nasogastric tube (Ryles tube) and routine laparoscopic instruments were used to perform laparoscopic FJ. Perioperative data and postoperative outcomes were analyzed. Results Baseline preoperative variables were comparable in both groups. The median operative duration in the laparoscopic FJ group was 180 minutes vs. 60 minutes in the open FJ group (p = 0.01). Postoperative length of hospital stay was 3 days vs. 4 days in the laparoscopic and open FJ groups, respectively (p = 0.08). Four patients in the open FJ group suffered from an immediate postoperative complication (none in the laparoscopic FJ group). After a median follow-up of 10 months, fewer patients in the laparoscopic FJ group had complications such as tube clogging, tube dislodgement, surgical-site infection, and small bowel obstruction. Conclusion Laparoscopic FJ with the Witzel technique is a safe and feasible procedure with a comparable outcome to the open technique. Patient selection is vital to overcome the initial learning curve.
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Affiliation(s)
- Peeyush Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
- Corresponding author Peeyush Varshney, Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni Industrial Area Phase II, Jodhpur 342005, India, E-mail: , ORCID: https://orcid.org/0000-0001-6276-1890
| | - Vignesh N
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Vaibhav Kumar Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Subhash Soni
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Selvakumar B
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Lokesh Agarwal
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Ashish Swami
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
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4
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Hsiung T, Chao WP, Chai SW, Chou TC, Wang CY, Huang TS. Laparoscopic vs. open feeding jejunostomy: a systemic review and meta-analysis. Surg Endosc 2022; 37:2485-2495. [PMID: 36513780 DOI: 10.1007/s00464-022-09782-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Feeding jejunostomy is a solid way for patients to maintain enteral nutrition. However, debate over the superiority of the laparoscopic vs. laparotomic method has raised concerns in recent years. This systemic review and meta-analysis aimed to compare the postoperative outcomes between these two approaches. METHODS We searched PubMed, Embase, and Scopus from the date of inception to April 2022 for studies comparing laparoscopic and open feeding jejunostomy. Study characteristics and outcomes were extracted from the included articles. The primary outcome was the relative risk (RR) of postoperative complications in each group. We also analyzed the major/minor complication rates and operations, excluding major concomitant procedures. The risk of bias of included studies were assessed using the ROBINS-I tool. The certainty of evidence was rated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS A total of seven retrospective studies with 1195 patients in total were included in this systemic review and meta-analysis. Laparoscopic feeding jejunostomy carried a significantly lower postoperative complication rate (RR: 0.62; 95% CI, 0.42-0.91, p = 0.02, low certainty of evidence) compared with laparotomy, and the heterogeneity was moderate (I2 = 34%, p = 0.18). After excluding major concomitant procedures, the RR between the laparoscopic and open group was 0.48 (95% CI, 0.33-0.70, p < 0.001, low certainty of evidence), suggesting that the laparoscopic approach was superior in terms of postoperative complications. CONCLUSIONS Our results indicate that laparoscopic feeding jejunostomy might reduce the postoperative overall complication rate compared with open feeding jejunostomy.
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Affiliation(s)
- Ted Hsiung
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Wu-Po Chao
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Shion Wei Chai
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Ta-Chun Chou
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Chih-Yuan Wang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Ting-Shuo Huang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan. .,Department of Chinese Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, 259, Taiwan. .,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, 20401, Taiwan.
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5
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Nakai T, Kitadani J, Ojima T, Hayata K, Katsuda M, Goda T, Takeuchi A, Tominaga S, Fukuda N, Nagano S, Yamaue H. Feeding jejunostomy following esophagectomy may increase the occurrence of postoperative small bowel obstruction. Medicine (Baltimore) 2022; 101:e30746. [PMID: 36123872 PMCID: PMC9478262 DOI: 10.1097/md.0000000000030746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study aimed to clarify the characteristics and treatment of bowel obstruction associated with feeding jejunostomy in patients who underwent esophagectomy for esophageal cancer. In this single-center retrospective study, 363 patients underwent esophagectomy with mediastinal lymph node dissection for esophageal cancer at the Wakayama Medical University Hospital between January 2014 and June 2021. All patients who underwent esophagectomy routinely underwent feeding jejunostomy or gastrostomy. Feeding jejunostomy was used in the cases of gastric tube reconstruction through the posterior mediastinal route or colon reconstruction, while feeding gastrostomy was used in cases of retrosternal route gastric tube reconstruction. Nasogastric feeding tubes and round ligament technique were not used. Postoperative small bowel obstruction occurred in 19 of 197 cases of posterior mediastinal route reconstruction (9.6%), but in no cases of retrosternal route reconstruction because of the feeding gastrostomy (P < .0001). Of the 19 patients who had bowel obstruction after feeding jejunostomy, 10 patients underwent reoperation (53%) and the remaining 9 patients had conservative treatment (47%). The cumulative incidence of bowel obstruction after feeding jejunostomy was 6.7% at 1 year and 8.7% at 2 years. Feeding jejunostomy following esophagectomy is a risk factor for small bowel obstruction. We recommend feeding gastrostomy inserted from the antrum to the jejunum in the cases of gastric tube reconstruction through the retrosternal route or nasogastric feeding tube in the cases of reconstruction through the posterior mediastinal route.
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Affiliation(s)
- Tomoki Nakai
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Junya Kitadani
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Toshiyasu Ojima
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
- *Correspondence: Toshiyasu Ojima, Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan (e-mail: )
| | - Keiji Hayata
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Katsuda
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Taro Goda
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akihiro Takeuchi
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shinta Tominaga
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Naoki Fukuda
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shotaro Nagano
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
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6
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Postpyloric Feeding Access in Infants and Children: A State of the Art Review. J Pediatr Gastroenterol Nutr 2022; 75:237-243. [PMID: 35696699 DOI: 10.1097/mpg.0000000000003518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Achieving postpyloric feeding access is a clinical challenge faced by the pediatric gastroenterologist in everyday practice. Currently, there is limited literature published on the topic. This article provides a practical summary of the literature on the different methods utilized to achieve postpyloric feeding access including bedside, fluoroscopic, endoscopic and surgical options. Indications and complications of these methods are discussed as well as a general approach to infants and children that require intestinal feeding.
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Marlor D, Noor S, Beck J, Taghlabi KM, Al-Kasspooles M. Jejunojejunal intussusception of a sutured enterotomy site after takedown and primary repair of persistent enterocutaneous fistula: a case report. J Surg Case Rep 2022; 2022:rjac399. [PMID: 36158243 PMCID: PMC9491862 DOI: 10.1093/jscr/rjac399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 11/12/2022] Open
Abstract
Enterocutaneous fistula (ECF) is a common complication of many abdominal surgeries. Although most ECF resolve spontaneously, there are many factors that can lead to persistence of the fistula. Management of persistent enterocutaneous fistula usually involves surgery with recurrence of fistula being the most common complication. Here we describe a case of 67-year-old female who presented with intussusception following repair of a persistent enterocutaneous. Given the rare finding of intussusception in adults, this case report presents an interesting complication.
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Affiliation(s)
- Derek Marlor
- Department of General Surgery, University of Kansas Medical Center , Kansas City, KS , USA
| | - Sibat Noor
- University of Kansas School of Medicine , Kansas City, KS , USA
| | - Justin Beck
- Department of General Surgery, University of Kansas Medical Center , Kansas City, KS , USA
| | - Khaled M Taghlabi
- Department of General Surgery, University of Kansas Medical Center , Kansas City, KS , USA
| | - Mazin Al-Kasspooles
- Department of General Surgery, University of Kansas Medical Center , Kansas City, KS , USA
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8
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Tsuchiya H, Yasufuku I, Okumura N, Matsuhashi N, Takahashi T. Laparoscopic jejunostomy for enteral nutrition in gastric cancer patients: A report of two cases: A case report. Int J Surg Case Rep 2022; 97:107388. [PMID: 35868129 PMCID: PMC9403088 DOI: 10.1016/j.ijscr.2022.107388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/03/2022] [Accepted: 07/03/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Jejunostomy is often indicated for patients with oral intake difficulties and unresectable gastric cancer, patients at risk of postoperative complications, and patients who require nutritional management after gastrectomy. In this report, we discuss the cases with laparoscopic jejunostomy in our department. CASE PRESENTATION Case 1: An upper gastrointestinal endoscopy performed for close examination in a 60-year-old male revealed upper gastric cancer with extensive invasion and lower esophageal stenosis. He had difficulty with esophageal transit and, consequently, underwent a laparoscopic jejunostomy and staging laparoscopy. Case 2: Upper gastrointestinal endoscopy in a 62-year-old male revealed type 3 tumor in the gastric antrum. He had a history of chronic obstructive pulmonary disease requiring home oxygen therapy, pulmonary hypertension, and heart failure, and was at a high perioperative risk. Consequently, both laparoscopic distal gastrectomy and laparoscopic jejunostomy were performed. CLINICAL DISCUSSION Enteral nutrition has many advantages over venous nutrition, including maintenance of immunity and intestinal mucosa, avoidance of bacterial translocation, and decreased risk of catheter infection. Although there are a few reports of cases with laparoscopic jejunostomy, it is expected that the technique will become more widespread and safe in the future. CONCLUSION Laparoscopic jejunostomy is considered a useful, minimally invasive, and safe technique.
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9
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Zhuang W, Wu H, Liu H, Huang S, Wu Y, Deng C, Tian D, Zhou Z, Shi R, Chen G, Piessen G, Khaitan PG, Koyanagi K, Ozawa S, Qiao G. Utility of feeding jejunostomy in patients with esophageal cancer undergoing esophagectomy with a high risk of anastomotic leakage. J Gastrointest Oncol 2021; 12:433-445. [PMID: 34012637 PMCID: PMC8107594 DOI: 10.21037/jgo-21-133] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/09/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Feeding jejunostomy is widely used for enteral nutrition (EN) after esophagectomy; however, its risks and benefits are still controversial. We aimed to evaluate the short-term and long-term outcomes of feeding jejunal tube (FJT) in patients undergoing esophagectomy for esophageal squamous cell carcinoma (ESCC) who were deemed high-risk for anastomotic leakage. METHODS We retrospectively analyzed 716 patients who underwent esophagectomy with (FJT group, n=68) or without (control group, n=648) intraoperative placement of FJT. Propensity score matching (PSM) was used for the adjustment of confounding factors. Risk level for anastomotic leakage was determined for every patient after PSM. RESULTS Patients in the FJT group were at higher risk of anastomotic leakage (14.9% vs. 11.3%), and had a statistically non-significant increase of postoperative complications [31.3% vs. 21.8%, odds ratio (OR) =1.139, 95% confidence interval (CI), 0.947-1.370, P=0.141] after PSM. Medical expenditure, length of postoperative hospital stay, and short-term mortality were similar between the FJT and control groups. Placement of FJT appeared to accelerate the recovery of anastomotic leakage (27.2 vs. 37.4 d, P=0.073). Patients in FJT group achieved comparable overall survival (OS) both before [hazard ratio (HR) =0.850, P=0.390] and after (HR =0.797, P=0.292) PSM. CONCLUSIONS FJT showed acceptable safety profile along with potential benefits for ESCC patients with a high presumed risk of anastomotic leakage. While FJT does not impact OS, placement of FJT should be considered in esophagectomy patients and tailored to individual patients based on their leak-risk profile.
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Affiliation(s)
- Weitao Zhuang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Hansheng Wu
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Huiling Liu
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shujie Huang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Yinghong Wu
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Cheng Deng
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Dan Tian
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zihao Zhou
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruiqing Shi
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Gang Chen
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guillaume Piessen
- University of Lille, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - Puja G. Khaitan
- Division of Thoracic and Esophageal Surgery, Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Kazuo Koyanagi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Soji Ozawa
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Guibin Qiao
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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10
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Tsai HI, Chou TC, Yu MC, Yeh CN, Peng MT, Hsieh CH, Su PJ, Wu CE, Kuo YC, Chiu CC, Lee CW. Purely laparoscopic feeding jejunostomy: a procedure which deserves more attention. BMC Surg 2021; 21:37. [PMID: 33441134 PMCID: PMC7805100 DOI: 10.1186/s12893-021-01050-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/04/2021] [Indexed: 01/17/2023] Open
Abstract
Background Laparoscopic procedure has inherent merits of smaller incisions, better cosmesis, less postoperative pain, and earlier recovery. In the current study, we presented our method of purely laparoscopic feeding jejunostomy and compared its results with that of conventional open approach. Methods We retrospectively reviewed our patients from 2012 to 2019 who had received either laparoscopic jejunostomy (LJ, n = 29) or open ones (OJ, n = 94) in Chang Gung Memorial Hospital, Linkou. Peri-operative data and postoperative outcomes were analyzed. Results In the current study, we employed 3-0 Vicryl, instead of V-loc barbed sutures, for laparoscopic jejunostomy. The mean operative duration of LJ group was about 30 min longer than the OJ group (159 ± 57.2 mins vs 128 ± 34.6 mins; P = 0.001). There were no intraoperative complications reported in both groups. The patients in the LJ group suffered significantly less postoperative pain than in the OJ group (mean NRS 2.03 ± 0.9 vs. 2.79 ± 1.2; P = 0.002). The majority of patients in both groups received early enteral nutrition (< 48 h) after the operation (86.2% vs. 74.5%; P = 0.143). Conclusions Our study demonstrated that purely laparoscopic feeding jejunostomy is a safe and feasible procedure with less postoperative pain and excellent postoperative outcome. It also provides surgeons opportunities to enhance intracorporeal suture techniques.
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Affiliation(s)
- Hsin-I Tsai
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
| | - Ta-Chun Chou
- Department of Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Ming-Chin Yu
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan, Republic of China.,Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated By Chang Gung Medical Foundation), Tu-Cheng, New Taipei City, Taiwan, Republic of China
| | - Chun-Nan Yeh
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan, Republic of China
| | - Meng-Ting Peng
- Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Chia-Hsun Hsieh
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China.,Division of Hematology and Oncology, Department of Internal Medicine, New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), Tu-Cheng, New Taipei City, Taiwan, Republic of China
| | - Po-Jung Su
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Chiao-En Wu
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Yung-Chia Kuo
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Chien-Chih Chiu
- Department of Nursing, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Chao-Wei Lee
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China. .,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China. .,Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan, Republic of China.
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11
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Kamada T, Ohdaira H, Takeuchi H, Takahashi J, Marukuchi R, Ito E, Suzuki N, Narihiro S, Hoshimoto S, Yoshida M, Urashima M, Suzuki Y. Vertical distance from navel as a risk factor for bowel obstruction associated with feeding jejunostomy after esophagectomy: a retrospective cohort study. BMC Gastroenterol 2020; 20:354. [PMID: 33109092 PMCID: PMC7590660 DOI: 10.1186/s12876-020-01506-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022] Open
Abstract
Background Placement of feeding jejunostomy (PFJ) during esophagectomy is an effective method to maintain adequate nutrition, but is associated with serious complications such as bowel obstruction and jejunal torsion. The purpose of the current study was to analyze the incidence, clinical features, and risk factors of bowel obstruction associated with feeding jejunostomy (BOFJ) after PFJ. Methods This was a retrospective cohort study of 70 patients who underwent esophagectomy with three-field lymph node dissection for esophageal cancer and treated with PFJ between March 2013 and December 2019 in our hospital. Abdominal dissection was performed under hand-assisted laparoscopic surgery (HALS) from March 2013 to March 2015, and was changed to complete laparoscopic surgery in April 2015. We compared patients with and without BOFJ, and the incidence of BOFJ was evaluated. The primary endpoint was incidence of BOFJ after PFJ. Results Six patients (8.5%) were diagnosed with BOFJ, all of whom were symptomatic and in the HALS group. In addition, 3 cases displayed histories of recurrent BOFJ (3, 3, and 5 times). Laparotomy was performed in all cases. Subgroup analysis of the HALS group showed a significant difference only in straight-line distance between the jejunostomy and navel as a significant pre- and perioperative factor (117 mm [101–130 mm] vs. 89 mm [51–150 mm], p < 0.001). Furthermore, dividing straight-line distance between the jejunostomy and navel into VD and HD, only VD differed significantly (107 mm [93–120 mm] vs. 79 mm [28–135 mm], p = 0.010), not HD (48 mm [40–59 mm] vs. 46 mm [22–60 mm], p = 0.199). Conclusions VD between the jejunostomy and navel was associated with BOFJ after PFJ with HALS esophagectomy. PFJ < 9 cm above the navel during HALS esophagectomy might effectively prevent BOFJ.
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Affiliation(s)
- Teppei Kamada
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan.
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Hideyuki Takeuchi
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Junji Takahashi
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Rui Marukuchi
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Eisaku Ito
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Norihiko Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Satoshi Narihiro
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Sojun Hoshimoto
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Mitsuyoshi Urashima
- Division of Molecular Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
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12
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Complications of feeding jejunostomy placement: a single-institution experience. Surg Endosc 2020; 35:3989-3997. [PMID: 32661711 DOI: 10.1007/s00464-020-07787-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Feeding jejunostomy is an alternative route of enteral nutrition in patients undergoing major gastrointestinal operations when a feeding gastrostomy is not suitable. METHODS A single institution review of patients who underwent open or laparoscopic jejunostomy tube (JT) placement between 2009 and 2019 was performed. Data collected included demographics, preoperative serum albumin, surgery indication, concomitancy of procedure, size of JT tube and time to its removal. JT complications were analyzed in the early postoperative period (< 30 days) and in a long-term follow-up (> 30 days). The Chi-square test was used to compare rates of complications according to tube size. RESULTS Seventy-three patients underwent JT placement, and gastroesophageal cancer (n = 48, 65.7%) was the most common indication. The JT was most frequently placed concomitantly (n = 56, 76.7%) to the primary operation and through a laparoscopic approach (n = 66, 90.4%). A total of 14 patients (19.1%) had early complications and 15 had late complications (20.5%). The reasons for early complications were clogged JT (n = 8, 10.9%), JT dislodgement (n = 3, 4.1%), leakage (n = 2, 2.7%), small bowel obstruction adjacent to the site of the jejunostomy tube (n = 2, 2.7%), JT site infection (n = 1, 1.3%), and intraperitoneal JT displacement (n = 1, 1.3%). The reasons for late complications were clogged JT (n = 6, 8.2%), JT dislodgement (n = 6, 8.2%), JT site infection (n = 3, 4.1%), and JT leakage (n = 1, 1.3%). There was no procedure-related mortality in this series. However, 12 patients (16.4%) died due to their baseline disease. The mean time to tube removal was 83.4 ± 93.6 days. The most frequently used JT size was 14 French (n = 39, 53.4%) but in nine patients the tube size was not reported. No statistical significance (p = 0.75) was found when comparing the two most commonly used sizes to rates of complications. CONCLUSION The rate of JT complications in our study is comparable to other published reports in literature. As an alternative route for nutritional status optimization, the procedure appears to be safe despite the number of complications.
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13
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Kim CY, Dai R, Wang Q, Ronald J, Zani S, Smith TP. Jejunostomy Tube Insertion for Enteral Nutrition: Comparison of Outcomes after Laparoscopic versus Radiologic Insertion. J Vasc Interv Radiol 2020; 31:1132-1138. [PMID: 32460963 DOI: 10.1016/j.jvir.2019.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To retrospectively compare technical success and major complication rates of laparoscopically versus radiologically inserted jejunostomy tubes. MATERIALS AND METHODS In this single-institution retrospective study, 115 patients (60 men; mean age, 59.7 y) underwent attempted laparoscopic jejunostomy tube insertion as a standalone procedure during a 10-year period and 106 patients (64 men; mean age, 61.0 y) underwent attempted direct percutaneous radiologic jejunostomy tube insertion during an overlapping 6-year period. Clinical outcomes were retrospectively reviewed with primary focus on predictors of procedure-related major complications within 30 days. RESULTS Patients undergoing laparoscopic jejunostomy tube insertion were less likely to have previous major abdominal surgery (P < .001) or to be critically ill (P < .001) and had a higher body mass index (P = .001) than patients undergoing radiologic insertion. Technical success rates were 95% (110 of 115) for laparoscopic and 97% (103 of 106) for radiologic jejunostomy tube insertion (P = .72). Major procedural complications occurred in 7 patients (6%) in the laparoscopic group and in 5 (5%) in the radiologic group (P = 1.0). For laparoscopic jejunostomy tubes, only previous major abdominal surgery was significantly associated with a higher major procedure complication rate (14% [5 of 37] vs 3% [2 of 78] in those without; P = .039). In the radiologic jejunostomy group, only obesity was significantly associated with a higher major complication rate: 20% (2 of 10) vs 3% (3 of 96) in nonobese patients (P = .038). CONCLUSIONS Laparoscopic and radiologic jejunostomy tube insertion both showed high success and low complication rates. Previous major abdominal surgery and obesity may be pertinent discriminators for patient selection.
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Affiliation(s)
- Charles Y Kim
- Division of Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710.
| | - Rui Dai
- Division of Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710
| | - Qi Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - James Ronald
- Division of Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710
| | - Sabino Zani
- Department of Surgery, Duke University Medical Center, Box 3808, Durham, NC, 27710
| | - Tony P Smith
- Division of Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710
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14
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Collard MK, Genser L, Vaillant JC. Re Re : laparoscopic direct feeding jejunostomy. J Visc Surg 2020; 157:167-168. [PMID: 31959468 DOI: 10.1016/j.jviscsurg.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M K Collard
- Service de chirurgie digestive hépato-bilio-pancréatique et transplantation hépatique, Institut hospitalo-universitaire ICAN, groupe hospitalier Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - L Genser
- Service de chirurgie digestive hépato-bilio-pancréatique et transplantation hépatique, Institut hospitalo-universitaire ICAN, groupe hospitalier Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France.
| | - J C Vaillant
- Service de chirurgie digestive hépato-bilio-pancréatique et transplantation hépatique, Institut hospitalo-universitaire ICAN, groupe hospitalier Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
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15
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Deffain A, Crombé T, Piessen G. RE : Direct laparoscopic feeding jejunostomy. J Visc Surg 2020; 157:169. [PMID: 31959467 DOI: 10.1016/j.jviscsurg.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- A Deffain
- Service de chirurgie digestive, endocrinienne, oncologique et transplantation hépatique, hôpital Trousseau, CHRU de Tours, Tours, France; Service de chirurgie digestive et oncologique, hôpital Claude-Huriez, 59000 Lille, France
| | - T Crombé
- Service de chirurgie digestive et oncologique, hôpital Claude-Huriez, 59000 Lille, France
| | - G Piessen
- Service de chirurgie digestive et oncologique, hôpital Claude-Huriez, 59000 Lille, France; University Lille, UMR-S 1172-CANTHER laboratory ``Cancer Heterogeneity, Plasticity and Resistance to Therapies'',59045 Lille, France.
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16
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Shiraishi O, Kato H, Iwama M, Hiraki Y, Yasuda A, Peng YF, Shinkai M, Kimura Y, Imano M, Yasuda T. A simple, novel laparoscopic feeding jejunostomy technique to prevent bowel obstruction after esophagectomy: the "curtain method". Surg Endosc 2019; 34:4967-4974. [PMID: 31820160 DOI: 10.1007/s00464-019-07289-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Feeding jejunostomy (FJ) is a common treatment to support patients with esophageal cancer after esophagectomy. However, severe FJ-related complications, such as bowel obstruction, occasionally occur. We investigated the ability of our simple, novel FJ technique, the "curtain method," to prevent bowel obstruction. METHODS In laparoscopic surgery, the main mechanism of bowel obstruction involves torsion of the mesentery accompanied by migration of the intestine across the fixed FJ through the space surrounded by a triangle comprising the ligament of Treitz, fixed FJ, and spleen rather than adhesion. Our "curtain method" involves closure of this triangle zone with omentum, and the appearance of the lifted omentum resembles a curtain. Sixty patients treated with this modified FJ were retrospectively compared with 13 patients treated with conventional FJ in terms of the incidence of bowel obstruction, peritonitis, stoma site infection, and catheter obstruction. RESULTS From 2013 to 2017, 60 patients underwent esophagectomy and gastric conduit reconstruction accompanied by modified laparoscopic FJ. The median observation period, including the period after tube removal, was 644 days. No FJ-associated bowel obstruction, the prevention of which was the primary aim, occurred in any patient. Likewise, no peritonitis or dislodgement occurred. Eight patients (13%) developed a stoma site infection with granulation. The feeding tube became occluded in 11 patients (18%); however, a new feeding tube was reinserted under fluoroscopy for all of these patients. From 2003 to 2012, 13 patients underwent conventional FJ. The median observation period was 387 days. Three patients (23%) developed bowel obstruction by torsion 71 to 134 days after the first surgery, and all were treated by emergency operations. Other FJ-related complications were not different from those in the modified FJ group. CONCLUSION Our simple, novel technique, the "curtain method," for prevention of laparoscopic FJ-associated bowel obstruction after esophagectomy is a safe additional surgery.
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Affiliation(s)
- Osamu Shiraishi
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan.
| | - Hiroaki Kato
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Mitsuru Iwama
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Yoko Hiraki
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Atsushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Ying-Feng Peng
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Masayuki Shinkai
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Yutaka Kimura
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Motohiro Imano
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Takushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
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17
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Klevebro F, Johar A, Lagergren J, Lagergren P. Outcomes of nutritional jejunostomy in the curative treatment of esophageal cancer. Dis Esophagus 2019; 32:5212877. [PMID: 30496419 DOI: 10.1093/dote/doy113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Substantial weight loss and eating problems are common before and after esophagectomy for cancer. The use of jejunostomy might prevent postoperative weight loss, but studies evaluating other outcomes are scarce. This study aims to assess the influence of jejunostomy on postoperative health-related quality of life (HRQOL), complications, reoperation, hospital stay, and survival. This prospective and population-based cohort study included all patients operated on for esophageal or gastroesophageal junction cancer in Sweden in 2001-2005 with follow-up until 31st December 2016. Data regarding patient and tumor characteristics and treatment were prospectively collected. Multivariable logistic regression provided odds ratios (OR) with 95% confidence intervals (CI), whereas Cox regression provided hazard ratios with 95% CI. All risk estimates were adjusted for age, sex, tumor histology, stage, comorbidity, surgical approach, neoadjuvant therapy, and body mass index and weight loss at baseline. Among 397 patients, 181 (46%) received a jejunostomy during surgery. The use of jejunostomy did not influence the HRQOL at 6 months or 3 years after treatment. Jejunostomy users had no statistically significantly increased risk of postoperative complications (OR 1.27; 95% CI 0.86-1.87) or reoperation (OR 1.70; 95% CI 0.88-3.28). Intensive unit care and length of hospital stay was the same independent of the use of jejunostomy. The all-cause mortality was not increased in the jejunostomy group (HR 0.89, 95% CI: 0.74-1.07). This study indicates that jejunostomy does not influence postoperative HRQOL, complications, or survival after esophageal cancer surgery, it can be considered a safe method for early enteral nutrition after esophageal cancer surgery but benefits for the patients need further investigations.
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Affiliation(s)
- F Klevebro
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A Johar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - P Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Zhao ZW, Kang WM, Ma ZQ, Ye X, Yu JC. Gastric cancer with severe immune thrombocytopenia: A case report. World J Clin Cases 2018; 6:1024-1028. [PMID: 30568958 PMCID: PMC6288500 DOI: 10.12998/wjcc.v6.i15.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/31/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary immune thrombocytopenia (ITP) is a rare autoimmune disease associated with a high bleeding risk. For those patients with gastric cancer, surgical treatment may be the only option for therapy. Here, we present the first case of gastric cancer with severe and medically refractory ITP treated by radical resection of the gastric cancer and splenectomy. CASE SUMMARY A 54-year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite, nausea, vomiting, and weight loss, which progressed to difficulty in feeding 3 d prior to her visit. According to her medical history, she was diagnosed with refractory ITP [platelets (PLT), 3000-8000/μL] 10 years ago. After admission, the patient underwent a splenectomy and a distal subtotal gastrectomy (D2 radical resection) with Roux-en-Y reconstruction simultaneously. She had an uneventful postoperative course with a slight increase in her PLT count. This case is unique in terms of the patient's complication of severe and medically refractory ITP. CONCLUSION Simultaneous splenectomy, preoperative PLT transfusion, and early enteral nutrition were important treatment methods for helping this patient recover.
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Affiliation(s)
- Zhe-Wei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Wei-Ming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Zhi-Qiang Ma
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Jian-Chun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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Abstract
Palliative care is the multidisciplinary focus on patient symptoms and quality of life. The emphasis of minimally invasive surgery on reduced pain and faster recovery aligns well with the goals of palliative care. Minimally invasive approaches can be safely and effectively used to address several common complications of solid organ malignancies as well as the complications of cytotoxic therapy. A patient-centered, minimally invasive approach will not only help alleviate disabling symptoms and improve patient quality of life but will also minimize the pain and adverse effects of the intervention itself.
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Affiliation(s)
- Jordan M Cloyd
- Department of Surgery, The Ohio State University, 410 West 10th Avenue, N-907, Columbus, OH 43210, USA.
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20
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Singh RR, Eaton S, Roebuck DJ, Barnacle AM, Chippington S, Cross KMK, De Coppi P, Curry JI. Surgical jejunostomy and radiological gastro-jejunostomy tube feeding in children: risks, benefits and nutritional outcomes. Pediatr Surg Int 2018; 34:951-956. [PMID: 30014290 PMCID: PMC6105265 DOI: 10.1007/s00383-018-4303-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE Radiologically inserted gastrojejunal tubes (RGJ) and surgical jejunostomy (SJ) are established modes of jejunal feeding. The aim of the study is to review nutritional outcomes, complications and the practical consideration to enable patients and carers to make informed choice. METHODS Retrospective review of patient notes with a RGJ or SJ in 2010, with detailed follow-up and review of the literature. RESULTS Both RGJ and SJ are reliable modes to provide stable enteral nutrition. Both have complications and their own associated limitations. CONCLUSIONS The choice has to be tailored to the individual patient, the social care available, the inherent medical disease and risk/benefit of repeated anaesthetic and radiation exposure. RGJ and SJ are important tools for nutritional management that achieve and maintain growth in a complex group of children. The risk and benefits should be reviewed for each individual patient.
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Affiliation(s)
- Rashmi R. Singh
- Department of Paediatric Surgery, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Simon Eaton
- Department of Paediatric Surgery, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Derek J. Roebuck
- Department of Radiology, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Alex M. Barnacle
- Department of Radiology, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Samantha Chippington
- Department of Radiology, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Kate M. K. Cross
- Department of Paediatric Surgery, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Paolo De Coppi
- Department of Paediatric Surgery, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Joe I. Curry
- Department of Paediatric Surgery, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
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Huddy JR, Huddy FMS, Markar SR, Tucker O. Nutritional optimization during neoadjuvant therapy prior to surgical resection of esophageal cancer-a narrative review. Dis Esophagus 2018; 31:1-11. [PMID: 29024949 DOI: 10.1093/dote/dox110] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/21/2017] [Indexed: 12/11/2022]
Abstract
This narrative review aims to evaluate the evidence for the different nutritional approaches employed during neoadjuvant therapy in patients with locoregional esophageal cancer. Patients with esophageal cancer are often malnourished and difficult to optimize nutritionally. While evidence suggests that neoadjuvant therapy can offer a survival advantage, associated toxicity can exacerbate poor nutritional status. There is currently no accepted standard of care regarding optimal nutritional approach. A systematic literature search was undertaken. Studies describing the utilization of an additional nutritional intervention in patients with esophageal cancer receiving neoadjuvant therapy prior to esophagectomy were included. Primary outcome measure was 30-day postoperative mortality after esophagectomy. Secondary outcome measures were loss of weight during neoadjuvant therapy, completion rate of intended neoadjuvant therapy, complications from nutritional intervention, 30-day postoperative morbidity after esophagectomy and quality of life during neoadjuvant treatment. Given the heterogeneity of retrieved articles results was presented as a narrative review. Twenty-five studies were included of which 16 evaluated esophageal stenting, four feeding jejunostomy, three gastrostomy, one nasogastric feeding, and one comparative study of esophageal stenting to feeding jejunostomy. 30-day postoperative mortality was only reported in two of the 26 included studies limiting comparison between nutritional strategies. All studies of esophageal stents reported improvements in dysphagia with reported weight change ranging from -5.4 to +6 kg and one study reported 30-day postoperative mortality after esophagectomy (10%). In patients undergoing esophageal stenting for their neoadjuvant treatment overall migration rate was 29.9%. Studies of laparoscopically inserted jejunostomy were all retrospective reviews that demonstrated an increase in weight ranging from 0.4 to 11.8 kg and similarly no study reported 30-day postoperative mortality. Only one comparative study was included that compared esophageal stents to jejunostomy. This study reported no significant difference between the two groups in respect to complication rates (stents 22% vs. jejunostomy 4%, P = 0.11) or increase in weight (stents 4.4 kg vs. jejunostomy 4.2 kg, P = 0.59). Quality of life was also poorly reported. This review demonstrates the uncertainty on the optimal nutritional approach for patients with resectable esophageal cancer undergoing neoadjuvant treatment prior to esophagectomy. A prospective, multicenter, observational cohort study is needed to determine current practice and inform a prospective clinical trial.
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Affiliation(s)
- J R Huddy
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - F M S Huddy
- Department of Oesophago-Gastric Surgery, Royal Surrey County Hospital, Guildford, UK
| | - S R Markar
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - O Tucker
- Department of Oesophago-Gastric Surgery, Heart of England NHS Foundation Trust and University of Birmingham, UK
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22
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Srinivasa RN, Chick JFB, Hage AN, Shields JJ, Saad WE, Majdalany BS, Srinivasa RN. Transnasal Snare Technique for Retrograde Primary Jejunostomy Placement After Surgical Gastrojejunostomy. Cardiovasc Intervent Radiol 2017; 40:1940-1944. [PMID: 28879520 DOI: 10.1007/s00270-017-1777-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/21/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE To report a transnasal snare technique for retrograde primary jejunostomy placement after surgical gastrojejunostomy. MATERIALS AND METHODS Two patients underwent the transnasal snare technique for retrograde primary jejunostomy placement. Patients included two females, age 58 and 62. In both patients, a gooseneck snare was inserted in a transnasal fashion. After insertion of the snare into the jejunum, the location was confirmed with ultrasound. The snare was then targeted using a Chiba needle through which a 0.018-inch wire was advanced and snared through the nose. The wire was exchanged for a 0.035-inch Amplatz wire over which the tract was serially dilated followed by insertion of the jejunostomy catheter through a peel-away sheath. Technical success, complications, and follow-up were recorded. RESULTS Primary jejunostomy placement was technically successful in both patients. No minor or major complications occurred. Both patients received enteral nutrition the day following placement. Follow-up was at 54 and 38 days for patients 1 and 2, respectively. CONCLUSION The transnasal snare technique provides a novel alternative for primary jejunostomy insertion allowing for targeting of the jejunum with improved procedural success and no complications.
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Affiliation(s)
- Rajiv N Srinivasa
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Jeffrey Forris Beecham Chick
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Anthony N Hage
- University of Michigan Medical School, Medical Science Building I, 1301 Catherine St., Ann Arbor, MI, 48109-5624, USA
| | - James J Shields
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Wael E Saad
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Bill S Majdalany
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Ravi N Srinivasa
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
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23
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Krishnamurthy G, Pandit N, Singh H, Singh R. Successful Conservative Management of Spontaneous Antegrade Migration of Feeding Jejunostomy. Euroasian J Hepatogastroenterol 2017; 7:84-86. [PMID: 29201780 PMCID: PMC5663782 DOI: 10.5005/jp-journals-10018-1219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 10/30/2016] [Indexed: 01/17/2023] Open
Abstract
Successful conservative management of spontaneous antegrade migration of feeding jejunostomy of a patient with dysphagia due to carcinoma of nasopharynx is reported. How to cite this article: Krishnamurthy G, Pandit N, Singh H, Singh R. Successful Conservative Management of Spontaneous Antegrade Migration of Feeding Jejunostomy. Euroasian J Hepato-Gastroenterol 2017;7(1):84-86.
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Affiliation(s)
- Gautham Krishnamurthy
- Department of General Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Narendra Pandit
- Department of General Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Harjeet Singh
- Department of General Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Rajinder Singh
- Department of General Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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24
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Preoperative stenting in oesophageal cancer has no effect on survival: a propensity-matched case-control study†. Eur J Cardiothorac Surg 2017; 52:385-391. [DOI: 10.1093/ejcts/ezx097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/07/2017] [Indexed: 01/21/2023] Open
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25
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Siow SL, Mahendran HA, Wong CM, Milaksh NK, Nyunt M. Laparoscopic T-tube feeding jejunostomy as an adjunct to staging laparoscopy for upper gastrointestinal malignancies: the technique and review of outcomes. BMC Surg 2017; 17:25. [PMID: 28320382 PMCID: PMC5359869 DOI: 10.1186/s12893-017-0221-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background In recent years, staging laparoscopy has gained acceptance as part of the assessment of resectability of upper gastrointestinal (UGI) malignancies. Not infrequently, we encounter tumours that are either locally advanced; requiring neoadjuvant therapy or occult peritoneal disease that requires palliation. In all these cases, the establishment of enteral feeding during staging laparoscopy is important for patients’ nutrition. This review describes our technique of performing laparoscopic feeding jejunostomy and the clinical outcomes. Methods The medical records of all patients who underwent laparoscopic feeding jejunostomy following staging laparoscopy for UGI malignancies between January 2010 and July 2015 were retrospectively reviewed. The data included patient demographics, operative technique and clinical outcomes. Results Fifteen patients (11 males) had feeding jejunostomy done when staging laparoscopy showed unresectable UGI maligancy. Eight (53.3%) had gastric carcinoma, four (26.7%) had oesophageal carcinoma and three (20%) had cardio-oesophageal junction carcinoma. The mean age was 63.3 ± 7.3 years. Mean operative time was 66.0 ± 7.4 min. Mean postoperative stay was 5.6 ± 2.2 days. Laparoscopic feeding jejunostomy was performed without intra-operative complications. There were no major complications requiring reoperation but four patients had excoriation at the T-tube site and three patients had tube dislodgement which required bedside replacement of the feeding tube. The mean duration of feeding tube was 127.3 ± 99.6 days. Conclusions Laparoscopic feeding jejunostomy is an important adjunct to staging laparoscopy that can be performed safely with low morbidity. Meticulous attention to surgical techniques is the cornerstone of success.
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Affiliation(s)
- Sze Li Siow
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300, Kota Samarahan, Kuching, Sarawak, Malaysia.,Department of Surgery, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | | | - Chee Ming Wong
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300, Kota Samarahan, Kuching, Sarawak, Malaysia.,Department of Surgery, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | | | - Myo Nyunt
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300, Kota Samarahan, Kuching, Sarawak, Malaysia.
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26
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Ozkan H. HBV Treatment in Turkey: The Value of Hepatitis B Surface Antigen Quantification of Chronic Hepatitis B Patients in the Long-term Follow-up-A Single-center Study. Euroasian J Hepatogastroenterol 2017; 7:82-83. [PMID: 29201779 PMCID: PMC5663781 DOI: 10.5005/jp-journals-10018-1218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/05/2016] [Indexed: 11/23/2022] Open
Abstract
Hepatitis B surface antigen (HBsAg) seems to have significant clinical implications to assess the prognosis of chronic hepatitis B (CHB). We assessed HBsAg levels serially in patients with CHB in a single center in Turkey. How to cite this article: Ozkan H. HBV Treatment in Turkey: The Value of Hepatitis B Surface Antigen Quantification of Chronic Hepatitis B Patients in the Long-term Follow-up—A Single-center Study. Euroasian J Hepato-Gastroenterol 2017;7(1):82-83.
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Affiliation(s)
- Hasan Ozkan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
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27
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Speer EA, Chow SC, Dunst CM, Shada AL, Halpin V, Reavis KM, Cassera M, Swanström LL. Clinical Burden of Laparoscopic Feeding Jejunostomy Tubes. J Gastrointest Surg 2016; 20:970-5. [PMID: 26895952 DOI: 10.1007/s11605-016-3094-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 01/24/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Feeding jejunostomies (J tubes) provide enteral nutrition when oral and gastric routes are not options. Despite their prevalence, there is a paucity of literature regarding their efficacy and clinical burden. METHODS All laparoscopic J tubes placed over a 5-year period were retrospectively reviewed. Clinical burden was measured by number of clinical contact events (tube-related clinic visits, phone calls, ED visits) and morbidity (dislodgement, clogging, tube fracture, infection, other). Tube replacements were also recorded. RESULTS One hundred fifty-one patients were included. Fifty-nine percent had associated malignancy, and 35 % were placed for nutritional prophylaxis. Mean time to J tube removal was 146 days. J tubes were expected to be temporary in >90 % but only 50 % had sufficient oral intake for removal. Tubes were removed prematurely due to patient intolerance in 8 %. Mortality was 0 %. Morbidity was 51 % and included clogging (12 %), tube fracture (16 %), dislodgement (25 %), infection (18 %) and "other" (leaking, erosion, etc.) in 17 %. The median number of adverse events per J tube was 2(0-8). Mean number of clinic phone calls was 2.5(0-22), ED visits 0.5(0-7), and clinic visits 1.4(0-13), with 82 % requiring more than one J tube-related clinic visit. Unplanned replacements occurred in 40 %. CONCLUSION While necessary for some patients, J tubes are associated with high clinical burden.
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Affiliation(s)
- Emily A Speer
- Department of Surgery, Providence Portland Medical Center, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA
| | - Simon C Chow
- Department of Surgery, Legacy Good Samaritan Hospital, 1040 NW 22nd Ave, Suite 520, Portland, OR, 97210, USA
| | - Christy M Dunst
- Department of Surgery, Providence Portland Medical Center, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA. .,Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA. .,Foundation for Surgical Innovation and Education, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA.
| | - Amber L Shada
- Department of Surgery, Providence Portland Medical Center, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA
| | - Valerie Halpin
- Department of Surgery, Legacy Good Samaritan Hospital, 1040 NW 22nd Ave, Suite 520, Portland, OR, 97210, USA
| | - Kevin M Reavis
- Department of Surgery, Providence Portland Medical Center, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA.,Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA.,Foundation for Surgical Innovation and Education, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA
| | - Maria Cassera
- Department of Surgery, Providence Portland Medical Center, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA.,Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA.,Foundation for Surgical Innovation and Education, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA
| | - Lee L Swanström
- Department of Surgery, Providence Portland Medical Center, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA.,Department of Surgery, Legacy Good Samaritan Hospital, 1040 NW 22nd Ave, Suite 520, Portland, OR, 97210, USA.,Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA.,Foundation for Surgical Innovation and Education, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA.,Institut Hospitalo Universitaire Strasbourg, 1, Place de l'Hôpital, 97000, Strasbourg, France
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