Right gastroepiploic artery occlusion test for resection of recurrent lesion after esophageal reconstruction using a gastric tube.
BACKGROUND
Blood supply to a reconstructed gastric tube after esophagectomy is mainly through the right gastroepiploic artery (RGEA); therefore, a recurrent lesion involving the RGEA is thought to be unresectable, or if possible, resectable combined with a whole gastric tube.


METHODS
We developed a new method of right gastroepiploic artery occlusion test for evaluation of the blood circulation of a reconstructed gastric tube in a patient who has a recurrent lesion involving the RGEA. A balloon occlusion catheter is inserted into the RGEA through the celiac trunk through a 7 Fr angiographic catheter, and the balloon is inflated. Celiac angiography and color Doppler endoscopic ultrasonography can evaluate intragastric blood flow from the right gastric artery during occlusion of the RGEA.


RESULTS
We present a case of successful resection of celiac lymph node metastasis invading the RGEA and the celiac trunk after esophageal reconstruction using a gastric tube.


CONCLUSIONS
When ligation of the right gastroepiploic artery is needed, the test is safe and simple to perform; and findings can be reliably evaluated by angiography and color Doppler endoscopic ultrasonography.
Department of Surgery, Division of Surgical Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan. nyuasa@med.nagoya-u.ac.jp
Eiji
E
Hayashi
Norihiro
N
Yuasa
Eiji
E
Sasaki
Junichi
J
Kamiya
Masato
M
Nagino
Yuji
Y
Nimura
Yoshiki
Y
Hirooka
D000792:Angiography; D021721:Balloon Occlusion; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery; D018618:Echocardiography, Doppler, Color; D019074:Epigastric Arteries / Q000000981:diagnostic imaging*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012039:Regional Blood Flow; D012680:Sensitivity and Specificity; D013270:Stomach / Q000098:blood supply* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed