Gastric Tube Ulcer Research Articles

Changes in Acidity Levels in the Gastric Tube After Esophagectomy for Esophageal Cancer.

Reflux esophagitis and gastric tube ulcer sometimes cause severe clinical problems in patients undergoing esophagectomy with gastric tube reconstruction. We previously reported that acidity in the gastric tube was decreased for 1 year after esophagectomy, and that lower acidity levels were associated with Helicobacter pylori (H. pylori) infection. However, the long-term changes in gastric acidity remain unknown. We aimed to investigate the long-term changes in gastric acidity after surgery. Eighty-nine patients who underwent esophagectomy with gastric tube reconstruction for esophageal cancer were analyzed. They underwent 24-hour pH monitoring, serum gastrin measurement, and H. pylori infection examination before surgery, at 1 month, 1 year, and 2 years after surgery. The gastric acidity at 1 month and 1 year after surgery was significantly lower than that before surgery (p=0.003, p=0.003). However, there was no difference in gastric acidity before and 2 years after surgery. The gas tric acidity in H. pylori-infected patients was significantly lower in comparison to non-infected patients at each time point (p=0.0003, p<0.0001, p<0.0001, p<0.0001, respectively). In H. pylori-infected patients, gastric acid ity was decreased for 1 year after surgery, and recovered within 2 years after surgery. However, no significant differences were observed in the acidity levels of non-infected patients during the 2-year follow-up period. The serum gastrin level increased after esophagectomy. The acidity levels in the gastric tube recovered within 2 years after surgery. Periodic endoscopy examination is recommended for early detection of acid-related disease, such as reflux esophagitis or gastric tube ulcer, after esophagectomy with gastric tube reconstruction.

647. A CASE OF ACUTE GASTRIC TUBE ULCER BLEEDING SAVED BY EMERGENCY SURGERY

Abstract Gastric tube ulcer is recognized as one of the complications after esophageal cancer surgery. When a ulcer bleeds, or penetrates to the pericardial space, or perforates, it often follows a fatal course due to its anatomical position and the complexity of surgical treatment. We report a case of persistent bleeding from a gastric tube ulcer after esophageal cancer operation, which was unable to treat endoscopically. The case was a 67-year-old man. Thoracoscopic subtotal esophagectomy and posterior mediastinal route subtotal gastric reconstruction were performed for middle thoracic esophageal cancer. His fifth-year regular endoscopy revealed a gastric tube ulcer. As a cause of myalgia, the patient was prescribed NSAIDs every day by a nearby doctor. Initially, no bleeding was observed, and discontinuance of NSAIDs and conservative treatment with PPI was continued. However, five months later, sudden hematemesis was observed at night, and he was transferred to a nearby doctor. Emergency endoscopy revealed gastric tube ulcer bleeding. And he was transferred to our hospital in an emergency. However, two days later, hematemesis and persistent ulcer hemorrhage were observed. Due to the difficulty of cauterizing to heartbeat, emergency surgery was performed. The first attempt was made to approach by a posterior mediastinal route, but it was difficult to confirm the ulcer and it was difficult to control bleeding without compression. Adding the thoracotomy, the ulcer was confirmed under direct vision. An ulcer defect was about 5 cm, bleeding was from the ulcer margin. Barbed suture closure and the omental patch were performed. The postoperative course was uneventful and discharged from the hospital 21 days after the operation. We experienced a rare case of acute hemorrhagic gastric tube ulcer that was difficult to treat conservatively and was saved by emergency surgery. After reconstruction of esophageal cancer, there are complicated situations such as the route of the elevated gastric tube, the position of the ulcer, and the risk of perforation to the pericardial space. Prompt and accurate medical care is required.

A Case of Conservatively Treated Gastropericardial Fistula due to a Reconstructed Gastric Tube Ulcer after Esophagectomy for Cancer

A Case of Conservatively Treated Gastropericardial Fistula due to a Reconstructed Gastric Tube Ulcer after Esophagectomy for Cancer

255 OUTCOME OF ADDITIONAL ESOPHAGECTOMY AFTER NON-CURATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION FOR C-MM-SM1ESOPHAGEAL CANCER.

Abstract For patients diagnosed cT1(MM-SM1)N0 esophageal cancer, we perform endoscopic submucosal dissection (ESD) as a primary treatment. Furthermore, additional treatments were performed for the patients diagnosed pT1b(SM) in resected tumor by ESD. Our aim of this study is to investigate whether additional esophagectomy after non-curative ESD can be considered a valid treatment. Methods Forty-four patients who received esophagectomy with lymph node (LN) dissection in neck, mediastinum and upper abdomen as additional surgery after non-curative ESD between 2006 and 2019 were enrolled. Histological examination revealed that squamous cell carcinoma in 41 and adenocarcinoma in 3 patients. We examined the rate of pathological LN metastasis and outcomes of patients received esophagectomy. Results The cT was LPM in 9(20%), MM-SM1 in 35 (80%) patients. However, the pT was MM in 3(7%), SM1 in 14 (32%) and SM2 in 27 (61%) patients. Lymphatic invasion was positive in 32 (73%) and venous invasion was positive in 16(36%) patients. Seven patients had pathological metastatic LN (1–2 LNs/case) (total 10 metastatic LNs). The metastatic LNs existed in neck, mediastinum and upper abdomen. The recurrences were occurred in 2 patients (No.106recL LN and No. 112ao-A LN). One patient died by esophageal cancer (LN recurrence, 38 months alive). One patient died of gastric tube ulcer perforation (16 months). Conclusion We showed that esophagectomy with extended LN dissection is sufficient as additional treatment for the patients treated non-curative ESD. To expand the indications of ESD for pSM esophageal cancer, new methods are needed, such as the risk diagnosis of LN metastasis using genetic analysis.

Gastric Tube Ulcer Perforation into the Pericardial Space after Esophagectomy for Esophageal Cancer Managed Successfully by Emergency Surgery

Gastric Tube Ulcer Perforation into the Pericardial Space after Esophagectomy for Esophageal Cancer Managed Successfully by Emergency Surgery

PS01.201: A CASE OF GASTRO-STERNAL FISTULA OF GASTRIC TUBE AFTER ESOPHAGECTOMY: A CASE REPORT

Abstract Background Peptic ulcer occurring in the gastric tube after esophagectomy sometimes penetrates into the mediastinal structures. We reported a case of sternal penetration of gastric tube ulcer successfully treated. Methods A CASE REPORT: Results A 73-years-old man who had undergone video-assisted thracoscopic esophagectomy (VATS) with 3-field lymphadenectomy reconstructed by retrosternal route after neoadjuvant chemo-radiation therapy. He visited outpatient complaining mild pain and redness of skin on anterior chest wall after 7 months of esophagectomy. Computed tomography (CT) revealed gastric tube ulcer penetrated into sternum. Upper GI endoscopy showed active ulcer in lower gastric tube. Biopsy was confirmed no malignant cell but bone tissues. He was admitted and started medication of proton pomp inhibiter and nutritional therapy. After 1 month he was improved symptoms and endoscopic findings. Conclusion There was a rare case of penetration into sternum due to gastric tube ulcer. In the literatures, 4 cases were reported about penetration into sternum. All four cases had symptoms of pain and redness of skin and were diagnosed with upper GI endoscopy and CT. Two cases underwent surgery and another cases were treated conservational therapy. Disclosure All authors have declared no conflicts of interest.

Results of neoadjuvant chemoradiotherapy with docetaxel, cisplatin, and 5-fuluorouracil for advanced esophageal cancer.

171 Background: We previously reported a phase I study of neoadjuvant chemoradiotherapy (CRT ) with docetaxel, cisplatin, and 5-fuluorouracil (DCF) for advanced esophageal cancer. After that, we continued to conduct neoadjuvant CRT with DCF as phase II study and here, we report the results of this study including phase I. Methods: We performed neoadjuvant CRT with DCF chemotherapy and concurrent radiation therapy (40Gy including irradiation field) in patients with advanced esophageal squamous cell carcinoma. Dose of chemotherapy were as follows: docetaxel 25mg/m2 (level 1 n=17), or 30mg/m2 (level 2 n=4) on day 1,15,29 and 43 and cisplatin 70mg/m2 on day 1,29 and 5-fuluorouracil on day 1-4 and 29-32. The tumors were resected during weeks 10-13. Results: From Dec 2009 to Aug 2012, 21patients were enrolled and 19 patients underwent thoracic surgery. There were 17 male and four female subjects of ages ranging from 38 to 72 years (median, 61 years). Of these, 6 patients had stage IIIA esophageal cancer and two had stage IIIB esophageal cancer. All the patients had squamous cell carcinoma. Pathological complete response of primary tumor was achieved in 12 patients (63%) and complete pathological response of both primary tumor and lymph node was seen in eight patients (42%). During CRT, the most common grade 3/4 non-hematological toxicity were anorexia (29%) and esophagitis (29%). During CRT, septic shock caused by infection via catheter was observed and re-operation was performed in one patient with reconstructed gastric tube necrosis.One patient developed recurrent gastric tube ulcer in the anastomotic part 4years after esophagectomy. 10 patients are alive more than 5 years and 5-year overall survival is 47.6% and three of them were level II cases. Conclusions: This preoperative CRT regimen using triplets result in favorite prognosis, but treatment plan should be reconsidered because of relative high toxicity. Because high complete response rate of primary tumor were observed and long-term survival has been obtained at a high rate in the case of level II, we planned new phase I/II study of CRT with DCF without preventive irradiation field. Clinical trial information: R000002555.

A Case of Reconstructed Gastric Tube Ulcer Penetrated Through to the Chest Wall

A Case of Reconstructed Gastric Tube Ulcer Penetrated Through to the Chest Wall

Gastric tube ulcer after esophagectomy

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.

Refractory Ulcer of Reconstructed Gastric Tube after Esophagectomy: A Case Report

We report a case in which rabeprazole cured gastric tube ulcer after esophagectomy for esophageal squamous cell carcinoma (ESCC). A 47-year-old Japanese man was referred to our hospital with refractory ulcer of the reconstructed gastric tube one year after esophagectomy for ESCC. The ulcer proved refractory to healing by the administration of omeprazole or lansoprazole, or eradication of Helicobacter pylori after examinations concerning ischemia, acid over-secretion and H. pylori infection. Finally, metabolizer type was examined for proton pump inhibitors (PPIs), revealing the patient as a hetero-extensive metabolizer for the CYP2C19 genotype. This suggested sensitivity to rabeprazole, but resistance to omeprazole and lansoprazole. The refractory ulcer was subsequently cured after changing the PPI to rabeprazole. Examination of PPI metabolizer type might thus be important, along with an investigation of ischemia, acid secretion and H. pylori infection in the treatment of refractory gastric tube ulcer after esophagectomy.

Successful Therapy of Brachiocephalic Arteriogastric Fistula After Esophagectomy

We report the case of an 86-year-old man, who had undergone subtotal esophagectomy and reconstruction with a gastric tube through the retrosternal route 7 years ago, who was referred for treatment of a brachiocephalic arteriogastric fistula. An emergency stent-graft placement was performed to prevent massive bleeding from the fistula. After 2 weeks, a follow-up esophagogastroscopy revealed that the gastric tube ulcer had been penetrated, and the stent graft was exposed. Therefore, surgical treatment was indicated. After a carotid-carotid arterial bypass graft was made, the brachiocephalic artery was resected with the stent graft and the gastric wall. The defect between the cervical esophagus and the remnant gastric tube was replaced by a free jejunal graft. The patient tolerated these procedures well and was transferred to the referral hospital 3 months after surgery. Therefore, both an early diagnosis and the administration of multidisciplinary treatment are essential to save patients presenting with an arterioenteric fistula.

A case of gastropericardial fistula of a gastric tube after esophagectomy: a case report and review

A 65-year-old man who had received an esophagectomy 10 years earlier was admitted to our hospital for right chest pain. Preoperative examinations showed pneumopericardium, a retrosternal gastric tube, and an active gastric tube ulcer. We diagnosed gastropericardial fistula of the gastric tube ulcer. Emergency surgery included lavage and drainage of the pericardial cavity and plombage of the rectus abdominis muscle flap to the posterior space of the gastric tube. Total parental nutrition and/or enteric nutrition were provided. Due to minor leakage from the ulcer, the patient could start oral intake on the postoperative 49th day, and was discharged from the hospital on the postoperative 86th day after physical rehabilitation. He has been free from complications for more than 33 months after surgery. Here, we review the literature and discuss the etiology and treatment of choice for this rare yet lethal complication in the follow-up after esophagectomy.

難治性再建胃管潰瘍から右心房穿孔を起こした１例

近年胃管潰瘍は，食道癌術後合併症のひとつとして認識されてきている。胃管潰瘍の穿孔は致命的であり，消化器以外の症状にも注意しなければならない。症例は72歳の男性で，過去に食道癌に対し食道亜全摘と後縦隔再建を行っていた。入院6か月前より胃管潰瘍を認め，保存的加療するも悪化していた。入院当初は肺炎として加療していたが，画像上で心嚢水が貯留，発熱と炎症反応高値が続き，精査中に突然のショックとなり，ICUに入室となった。入室後は抗菌薬，昇圧薬と輸血で一時ショックから離脱できたが，最終的に出血性ショックで永眠された。病理解剖で胃管潰瘍からの右心房穿孔が判明した。今回の症例を通して，食道癌術後合併症として，胃管潰瘍が重篤な状態を惹起することを十分認識し，潰瘍側が心嚢に接している場合や保存的加療に抵抗性のときは，心タンポナーデや心房穿孔に対する診断，治療の時機を失しないことが肝要である。

Late presentation of gastric tube ulcer perforation after oesophageal atresia repair

Ulcer formation in intrathoracic grafts after oesophageal replacement is considered an infrequent complication of the procedure. We present a rare case of a gastric tube ulcer with perforation, more than 30 years after gastric tube interposition for oesophageal atresia.

A Case of Refractory Gastric Tube Ulcer with Surgical Staple in the Ulcer Floor

症例は71歳，女性。平成16年11月当院にて難治性良性食道狭窄に対し非開胸食道抜去，胸壁前経路胃管再建を施行した。また3カ月前から腰痛症にてNSAIDを内服している。今回，平成17年4月胃管に一致した前胸部に皮膚の発赤と同部位からの出血を認め当科を受診した。緊急内視鏡にて胃管潰瘍穿孔と診断され入院となった。入院後はNSAIDを中止し，禁食，高カロリー輸液，PPIによる保存療法を行った。改善傾向を認め経口摂取開始後退院となった。同年8月，再び前胸部の出血を認め胃管潰瘍の再燃・穿孔の診断で入院となった。初回と同様の治療を行い穿孔部は閉鎖，潰瘍自体も改善傾向となったが経口摂取開始後に再び増悪した。Helicobacter pylori感染は陰性であった。内視鏡所見では潰瘍底に手術時のstapleを認めこれが再燃・治癒遷延の要因と考えられ内視鏡的に除去した。以後速やかに改善し同年11月退院となった。

Peptic ulcer of the gastric tube after esophagectomy for cancer: clinical implications

The use of the stomach as an esophageal substitute has become a well-established treatment procedure after esophagectomy for cancer. During the procedure, a bilateral truncal vagotomy is performed, which should prevent the occurrence of acid-related diseases in the gastric tube and in the remaining esophagus. We report the case of a man who presented a plugged perforated peptic ulcer that subsequently decompensated following endoscopic examination 1 year after a transthoracic esophagectomy with neoadjuvant chemo-radiation for a middle third squamous cell carcinoma. Resection of the ulcer and suture with a pleural patch was performed. There was no evidence of recurrent malignancy at time of surgery. The pathophysiology of gastric tube ulcer is multifactorial. Long-term treatment with an anti-secretory proton pump inhibitor may decrease esophageal complications of duodeno-gastric-esophageal reflux and could prevent the recurrence of gastric tube ulcers.

食道癌術後再建胃管潰瘍の心膜穿通をきたした1例

食道癌術後再建胃管潰瘍の心膜穿通をきたした1例

Twenty-one year experience with the pediatric gastric tube

From 1964 to 1985 inclusive, gastric tubes have been constructed in 36 infants and children to replace a congenitally defective esophagus or an esophagus with acquired irreparable damage. This report reviews our entire series to date covering a 21-year experience. There were 24 boys and 12 girls ranging in age from 3 months to 17 years. Twenty-two patients were operated on because of congenital esophageal defects and 14 for acquired lesions. A proximally based antiperistaltic tube was constructed in 32 instances, and a distally based isoperistaltic tube made in four. Thirty tubes were passed retrosternally, five through the chest (four with an anastomosis) and one subcutaneously. Twenty-nine infants and children had their tube construction staged, and the remaining seven had the entire procedure done in one stage. The spleen was removed in 23 early gastric tube operations. There were 19 extratube major complications. Twenty-four gastric tube neck anastomoses leaked (66%); all but one closed spontaneously within 3 months. There were 15 esophagogastric tube neck anastomotic strictures (41%), which were dilated; nine required resection. Thirty-two of the 36 infants and children have been followed for more than 1 year. Twenty-nine are swallowing normally, one is still being dilated, and one infant still does not swallow well. Mild sacculation or tortuosity of the gastric tube has been encountered only one. Growth was slow in four until the school years. One boy had his improperly made tube eventually discarded for a colon replacement. There were three deaths (tracheostomy complication, aspiration, gastric tube ulcer hemorrhage). Despite the above problems, the eventual outcome continues to be satisfactory and satisfying.(ABSTRACT TRUNCATED AT 250 WORDS)