Insertion of Transnasal Abscess Drainage Tube, Decompression Tube, and Jejunal Nutrition Tube Under Fluoroscopy to Treat Esophagojejunal Anastomotic Fistula After Gastrectomy for Gastric Cancer

Abstract

Background Esophagojejunal anastomotic leakage is a serious complication after total gastrectomy. This study evaluated the safety and efficacy of transnasal placement of drainage tube, jejunal decompression tube, and jejunal nutrition tube under fluoroscopy for treatment of esophagojejunal anastomotic fistula after gastrectomy in gastric cancer patients. Methods Retrospective review of patients with esophagojejunal anastomotic fistula treated with transnasal placement of abscess drainage tube, decompression tube, and jejunal nutrition tube under fluoroscopy. Fistula healing time, patient survival, and Eastern Cooperative Oncology Group (ECOG) performance status before and after treatment were evaluated. Results Thirty-eight patients were included in the study. Insertion of the transnasal abscess drainage tube, jejunal decompression tube, and nutrition tube was successful on the first attempt in all patients. Simple transnasal drainage was used in 27 patients (one drainage tube placed plus one drainage tube replacement in 15 patients, and one drainage tube placed in 12 patients), and transnasal drainage plus percutaneous abscess drainage in 11 patients. After placement of the tube, the mean volume of drainage was 120 ml (10–850 mL); the amount steadily decreased from then on. The fistula healed in 33 patients. Median time to fistula healing was 78 days (6-248 days). Two patients suffered gastrointestinal bleeding after the procedure but one patient died. Conclusions Transnasal insertion of transnasal abscess drainage tube, jejunal decompression tube, and jejunal nutrition tube under fluoroscopy appears to be a simple, minimally invasive, effective, and safe method for treating esophagojejunal anastomotic fistula after gastrectomy for gastric cancer.