Gastric tube ulcer after esophagectomy

Abstract

An ulcer occasionally develops in the gastric tube as an esophageal substitute after esophagectomy. The aim of the present study was to investigate the risk factors for a gastric tube ulcer. We reviewed the medical records of all 826 patients who underwent esophageal reconstruction using a gastric tube following esophagectomy, in Kurume University Hospital between 1985 and 2010. Potential risk factors for a gastric tube ulcer were investigated by comparing the clinical characteristics between patients with a gastric tube ulcer and those without, using a multivariate logistic regression model. Among the 826 patients, 30 patients (3.6 %) developed a gastric tube ulcer. In 19 cases without any signs or symptoms, the ulcer was found using upper endoscopy. In the other 11 patients, there were symptoms including hematemesis, chest pain, and/or abdominal pain. In 3 cases, the patient developed a severe complication from the ulceration such as perforation. Of these 3 cases, one patient died of massive bleeding from the left brachiocephalic vein. The multivariate analysis revealed that (1) a past history of a peptic ulcer, and (2) the period of treatment (meaning the more recent period after the introduction of systematic prevention and treatment for a gastric tube ulcer) were the only two risk factors for a gastric tube ulcer (p < 0.0001, and p = 0.033, respectively). Systematic prevention and treatment for a gastric tube ulcer including follow-up endoscopy, proton pump inhibitors administration according to 24-h pH monitoring, eradication of H. pylori, and others may decrease the incidence of a gastric tube ulcer. In particular, for patients with a past history of a peptic ulcer, the subcutaneous route of esophageal reconstruction is recommended to prevent fatal complications.