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An Esophagogastroduodenoscopy (EGD) is a diagnostic procedure in which an endoscopist uses a flexible, lighted endoscope to visualize the upper gastrointestinal (GI) tract. The procedure includes visualizing the oropharynx, esophagus, stomach, and the first part of the small intestine, the duodenum.
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Related Experiment Video

Updated: Oct 18, 2025

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
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ERAS guidelines-driven upper gastrointestinal contrast study after esophagectomy.

Francesco Puccetti1, Fredrik Klevebro2, MadhanKumar Kuppusamy1

  • 1Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA, 98101, USA.

Surgical Endoscopy
|October 1, 2021
PubMed
Summary

A protocol-driven upper GI contrast study aids early nasogastric tube removal after esophagectomy. This approach helps manage delayed gastric conduit emptying, leading to shorter hospital stays and adherence to enhanced recovery protocols.

Keywords:
Delayed Gastric emptyingERASEsophagectomyGastric conduit

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Critical Care Medicine

Background:

  • Early nasogastric tube (NGT) removal is crucial for enhanced recovery after surgery (ERAS) protocols in esophagectomy patients.
  • Delayed gastric conduit emptying (DGCE) can impede early NGT removal and prolonged hospital stays.
  • Standardized protocols are needed to manage DGCE and facilitate timely patient recovery.

Purpose of the Study:

  • To evaluate a protocol-driven upper gastrointestinal (UGI) contrast study for facilitating early NGT removal.
  • To assess the use of UGI contrast studies in directing therapeutic responses for DGCE.
  • To determine the impact of this protocol on patient recovery and hospital length of stay.

Main Methods:

  • Prospective enrollment of 50 esophagectomy patients between January 2017 and October 2019.
  • Systematic application of a standardized clinical protocol (SCP) involving UGI contrast study on postoperative days 2-3.
  • Targeted interventions for patients identified with DGCE based on contrast study findings.

Main Results:

  • 86% of patients achieved the targeted contrast study, leading to significantly earlier NGT removal (p=0.010).
  • Protocol adherence resulted in earlier oral feeding initiation (p=0.001) and a reduced length of hospital stay (6 vs. 10 days, p=0.024).
  • Four patients (8%) with DGCE successfully underwent protocoled treatment, with similar discharge times to the general cohort.

Conclusions:

  • Protocol-driven UGI contrast studies provide objective data to enable early NGT removal and hospital discharge.
  • Interventions for DGCE are effective in improving conduit emptying and achieving ERAS discharge goals.
  • This standardized approach enhances patient recovery following esophagectomy.