Replacement of a feeding tube through the gastric tube in patients after esophagectomy with retrosternal reconstruction.

Background: We present our technique of endoscopic replacement of the jejunostomy through the stomach conduit in patients after esophagectomy with retrosternal reconstruction.

Methods: After an upper gastrointestinal tract endoscopy was performed, the stomach conduit was sufficiently inflated with air and the site of the previously removed gastric tube was confirmed by the puncture using 23 G needle. After an approximately 6-mm incision was made under local anesthesia, a 4-mm peel-off introducer sheath was advanced into the stomach conduit under endoscopic control. A 3-mm jejunostomy tube was inserted through the sheath and placed into the jejunum using the endoscopic guidance. Using endoscopy, the jejunostomy tube was confirmed to be placed without bending.

Results: Between 1998 and 2006, subtotal esophagectomy with retrosternal cervical esophagogastrostomy was performed in 48 patients. All patients were inserted with at least either jejunostomy tube or decompression tube through the stomach conduit. Among them, 11 patients (23%) were performed percutaneous replacement jejunostomy through the stomach conduit. There were 9 men and 2 women whose mean age was 67 years (range: 59 to 76 y). Replacement of the jejunostomy tube was successful in all patients. The procedure required about 30 minutes. There were no deaths and no procedural complications. After 24 hours, the tube was used for enteral feeding. No late complication occurred in our cases.

Conclusions: We believe that the endoscopic percutaneous approach described in this report is safe and effective in patients after esophagectomy with retrosternal reconstruction.