Folded intraluminal drain tube stent in esophageal reconstruction with free jejunal flaps

We believe that this method of nasogastric (NG) tube stenting has the potential to improve the overall result of esophageal reconstruction using free jejunal autografts.

Microvascular transfer of bowel segments for esophageal reconstruction is indicated in the treatment of esophageal defects. Of the late complications resulting from esophageal reconstruction with jejunal flaps, the most common are stricture and fistula. NG tubes are placed at the time of bowel transfer and inset for gastric decompression and intraluminal stenting. We developed and evaluated a method to decrease these associated risks from NG tube stenting, while at the same time maximizing its use as a neo-esophageal stent in an attempt to prevent stricture formation.

Forty-two patients were evaluated from 1999 to 2004 who underwent cervical esophageal reconstruction following esophagectomy with a free jejunal autograft. An NG tube was folded proximally and secured to itself so that the doubled portion of the tube encompassed the reconstructed segment to decrease nasal airway morbidity and increase luminal dilatation and stenting. Timing of tube removal and complications were recorded.

The length of follow-up was 24 months. The NG tube was removed in all cases at 2 weeks postoperatively following a normal esophagogram. There were no cases of esophageal perforation or dislodgement. Two patients (4.7%) developed an esophagocutaneous fistula and two patients (4.7%) developed a stricture requiring surgical correction. There were no incidences of sinusitis, alar necrosis, bleeding or mucosal ulceration.