Long-distance esophagogastric submucosal dissection after minimal esophageal trauma of a gastric tube

Haemorrhagic exfoliative oesophagitis associated with nasogastric tube placement

A 92-year-old man hospitalised for cerebral infarction developed haematemesis. The patient was taking low-dose aspirin and apixaban for his cerebral infarction and non-valvular atrial fibrillation. His enteral nutrition was administrated through nasogastric tube. Upper endoscopy revealed active bleeding from a protruded lesion in the upper oesophagus. The lesion was removed by washing with a water jet, followed by successful endoscopic haemostasis. Histopathological examination revealed degenerated squamous epithelium without specific findings; the diagnosis was exfoliative oesophagitis. In our case, mechanical mucosal injury caused by nasogastric tube placement may result in exfoliative oesophagitis. In addition, the use of low-dose aspirin with apixaban may have contributed to the bleeding. We then performed a wire-guided nasogastric tube placement under fluoroscopy. No further bleeding was observed, but the patient died of sepsis 1 month later. This case highlights the importance of a risk assessment and management of oesophageal complications associated with nasogastric tube placement.

Submucosal Tunnel Formation as a Complication Caused by Long Intestinal Tube Insertion: A Case Report

We present a case of a 76-year-old man with submucosal tunnel formation caused by long intestinal tube (LIT) insertion. The patient had undergone an LIT insertion to treat bowel obstruction caused by ascending colon cancer. Although intestinal decompression was achieved successfully, a procedural pre-scheduled endoscopy incidentally revealed that the LIT had penetrated the abdominal esophageal mucosa and re-entered the gastric lumen, passing through the submucosal layer at the gastroesophageal junction. Therefore, the LIT was removed under endoscopic observation during ileocecal resection surgery and the patient was treated conservatively. The current case suggests that this unfamiliar complication can occur without any signs or symptoms.

Nasoenteric Tube Complications

The use of nasoenteric tubes (NETs) is ubiquitous, and clinicians often take their placement, function, and maintenance for granted. NETs are used for gastrointestinal decompression, enteral feeding, medication administration, naso-biliary drainage, and specialized indications such as upper gastrointestinal bleeding. Morbidity associated with NETETs is common, but frequently subtle, mandating high index of suspicion, clinical vigilance, and patient safety protocols. Common complications include sinusitis, sore throat and epistaxis. More serious complications include luminal perforation, pulmonary injury, aspiration, and intracranial placement. Frequent monitoring and continual re-review of the indications for continued use of any NETET is prudent, including consideration of changing goals of care. This manuscript reviews NET-related complications and associated topics.