title: Primary placement technique of jejunostomy using the entristar™ skin-level gastrostomy tube in patients with esophageal cancer.
abstract: BACKGROUND
  We developed a skin-level jejunostomy tube (SLJT) procedure for patients undergoing esophagectomy using a skin-level gastrostomy tube (G-tube) (Entristar™; Tyco Healthcare, Mansfield, Mass), in order to improve their nutrition status and quality of life (QOL). We describe the procedure and the adverse effects of SLJT in patients with esophageal cancer (EC).
  
  
  METHODS
  Over a 24-month period (March 2008 to March 2010), there were 16 patients (mean age: 61.8 years; age range: 49-75 years; 15 men, 1 woman) who had Stage II or III EC. Primary jejunostomy was performed under general anesthesia during esophagectomy. The technical success and the immediate and delayed complications of the procedure were recorded. JEJUNOSTOMY TECHNIQUES: SLJT placement using the G-tube (20Fr) was performed 20 cm from the Treitz ligament on the side opposing the jejunal mesenterium. The internal retention bolster was exteriorized through an incision in the abdominal wall. A single purse string suture using a 4-0 absorbable suture was performed. The internal retention bolster was then inserted into the jejunal lumen via the small incision. The intestine adjacent to the tube was anchored to the peritoneum using a single stitch.
  
  
  RESULTS
  The SLJT was successfully inserted in all 16 patients. No early complications were documented. Follow-up for a median of 107 days (range, 26-320 days) revealed leakage to the skin in four patients, including superficial wound infections in two patients. There were no cases of obstruction of the tube or procedure-related death.
  
  
  CONCLUSIONS
  This SLJT placement technique using the G-tube is a safe procedure in patients with EC and allows the creation of a long-term feeding jejunostomy.
authors.affiliation: Department of Surgery, Yokohama City University, School of Medicine 3-9, Fukuura, Kanazawa-ku, Yokohama city, 236-0004, Japan. rino@med.yokohama-cu.ac.jp
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Rino
authors.forename: Norio
authors.initials: N
authors.lastname: Yukawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Murakami
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Sato
authors.forename: Ken
authors.initials: K
authors.lastname: Takata
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Hayashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Oshima
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Wada
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
authors.forename: Toshio
authors.initials: T
authors.lastname: Imada
mesh_terms: D000368:Aged; D004750:Enteral Nutrition; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies