Significance of intraoperative endoscopy in total gastrectomy for gastric cancer

Nishikawa, Katsunori; Yanaga, Katsuhiko; Kashiwagi, Hideyuki; Hanyuu, Nobuyoshi; Iwabuchi, Shuuichi

doi:10.1007/s00464-010-1007-0

Cited by 27 publications

(19 citation statements)

References 18 publications

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“…Therefore, the lack of leaks in the studies of Lieto et al and nishikawa et al is questionable. nevertheless, the use of the methylene blue test significantly reduced the leakage rate in our experience, and the leakage rate (3.7%) in the tested group was similar to previous studies (14,18).…”

Section: Discussionsupporting

confidence: 91%

“…A little blue staining on the gauze was sufficient to locate and reinforce the leakage area. (18) 2010 retrospective 48 Endoscopy, air testing 1 (2.1) 0 (0) Kanaji et al (19) 2015 prospective 185 Through nasojejunal tube, air testing 6 (3.2) 9 (4.9)…”

Section: Discussionmentioning

confidence: 99%

“…Three studies on the technical approaches examined esophagojejunostomy anastomosis integrity intraoperatively in the literature (Table 2). Two of these studies used intraoperative endoscopy (IOE) and the air test, and the other study used the air test via a nasojejunal tube, and the air test was safe and reliable (14, 18, 19). The air–water test cannot delineate the exact focus of the leakage but the quadrant of leakage.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperatively Testing the Anastomotic Integrity of Esophagojejunostomy Using Methylene Blue

et al. 2016

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Background: Intraoperative testing of gastrointestinal anastomosis effectively ensures anastomotic integrity. this study investigated whether the routine use of methylene blue intraoperatively identified leaks to reduce the postoperative proportion of clinical leaks.Methods: this study retrospectively analyzed consecutive total gastrectomies performed from january 2007 to December 2014 in a university hospital setting by a general surgical group that exclusively used the methylene blue test. all surgeries were performed for gastric or junctional cancers (n = 198). all reconstructions (roux-en y esophagojejunostomy) were performed using a stapler. the methylene blue test was used in 108 cases (group 1) via a nasojejunal tube. no test was performed for the other 90 cases (group 2). Intraoperative leakage rate, postoperative clinical leakage rate, length of hospitalization, and mortality rate were the outcome measures.Results: the intraoperative leakage rate was 7.4% in group 1. the postoperative clinical leakage rate was 8.6%. the postoperative clinical leakage rate was 3.7% in group 1 and 14.4% in group 2 (p = 0.007). there were no postoperative clinical leaks when an intraoperative leak led to concomitant intraoperative repair. the median length of hospital stay was 6 days in group 1 and 8 days in group 2 (p < 0.001). one death occurred in each group. no test-related complications were observed.Conclusion: the methylene blue test for esophagojejunostomy is a safe and reliable method for the assessment of anastomosis integrity, especially in cases with difficult esophagojejunostomic construction.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intraoperatively Testing the Anastomotic Integrity of Esophagojejunostomy Using Methylene Blue

et al. 2016

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“…Together with a recent Japanese report, this is the first time that endoscopic IOAT has been investigated in esophagojejunal anastomoses. 28 A major issue regarding analysis of postoperative outcome in studies similar to ours lies in the definition of what constitutes a clinical anastomotic leak and how outcome data are interpreted. There is no consensus definition of anastomotic leak, and many studies have used a broad definition based on clinical and radiographic features, leading to confusing results.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Intraoperative Anastomotic Testing May Avoid Early Gastrointestinal Anastomotic Complications. A Prospective Study

Lieto

Orditura

Castellano

et al. 2011

Journal of Gastrointestinal Surgery

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“…The general scientific problem of insufficient evidence remains, with the exception of bariatric surgery, which offers large series of promising data [ 71 , 72 ]. The reliability of extrapolation to the oncosurgical anastomotic complication remains unclear [ 73 ].…”

Section: Discussionmentioning

confidence: 99%

Indications and benefits of intraoperative esophagogastroduodenoscopy.

Stašek

Aujeský

Vrba

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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IntroductionIntraoperative esophagogastroduodenoscopy (IOG) is a diagnostic and therapeutic method for a variety of special conditions in upper gastrointestinal (UGI) pathology. The indication remains individual due to insufficient evidence and limited training of surgeons in digestive endoscopy.AimTo evaluate the indications, benefits and risks of IOG.Material and methodsA single-center retrospective study of 110 consecutive IOGs in 104 patients was performed. The preoperative plan, the timing of IOG, preoperative evaluation, intraoperative finding, localization of the pathology, type of the procedure, change of expected therapy and complications were assessed.ResultsThe cohort comprised 29 esophageal tumors, 5 tumors of the cardia, 36 gastric tumors, gastrointestinal bleeding (8), esophageal diverticula (3), perforations (3), GERD (5), mediastinal pathology (3), fistula (4), assessment of nutrition (10), duodenal adenoma (2), ulcer disease, esophageal stenosis and gastric volvulus. The indication for IOG was established preoperatively in 79% and intraoperatively in 21%. The lesion was localized in 96.4%. The therapy was altered to a wider resection (11), smaller resection (5), localization and surgical therapy of bleeding (8) or allowed minimally invasive surgery (25). A total of 3 postoperative complications included gastric perforation and positivity of resection line (following EMR/ESD) and recurrent bleeding. The 30-day mortality reached 3.6% without a specific cause in IOG.ConclusionsThe IOG is a complementary method in the diagnosis and treatment of UGI pathology. It enables minimally invasive finalization of the procedures and individualization of the therapy.

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Significance of intraoperative endoscopy in total gastrectomy for gastric cancer

Abstract: IOE is safe and may easily provide significant information that can minimize PAL by detecting anastomotic failure on esophagojejunal anastomosis.

Cited by 27 publications

References 18 publications

Intraoperatively Testing the Anastomotic Integrity of Esophagojejunostomy Using Methylene Blue

Intraoperatively Testing the Anastomotic Integrity of Esophagojejunostomy Using Methylene Blue

Endoscopic Intraoperative Anastomotic Testing May Avoid Early Gastrointestinal Anastomotic Complications. A Prospective Study

Indications and benefits of intraoperative esophagogastroduodenoscopy.

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