title: Retrograde jejunogastric decompression after esophagectomy is superior to nasogastric drainage.
abstract: BACKGROUND
  Nasogastric tubes (NG) are commonly used for maintaining conduit decompression after esophagectomy. We investigated the use of retrograde tube gastrostomy (RG) after esophagectomy.
  
  
  METHODS
  Patients underwent either NG or RG placement for postoperative conduit decompression. Both tubes were maintained on low continuous suction.
  
  
  RESULTS
  Between 2000 and 2008, 306 patients underwent esophagectomy with reconstruction. One hundred ninety-three patients underwent NG and 113 underwent RG placement. The 2 groups were comparable in age, gender, tumor stage, and smoking status. Patients in the NG group were more likely to have received neoadjuvant therapy and to have a thoracotomy for esophagectomy. The incidence of respiratory complications was lower in the retrograde group compared with the NG group: Pneumonia, 9 of 113(8.0%) vs 50 of 193 (25.9%), p<0.001; respiratory failure requiring bronchoscopy or reintubation, 12 of 113 (10.8%) vs 46 of 193 (23.8%), p=0.004; aspiration, 4 of 113 (3.5%) vs 20 of 193 (10.4%), p=0.045. The incidence of cardiac dysrhythmias was also lower in the retrograde group (18 of 113 [15.9%] vs 69 of 193 [35.8%], p<0.001). The incidence of wound complications, myocardial infarction, stroke, and conduit necrosis-anastomotic leak was similar between groups. In a multivariate regression model an NG tube was the strongest predictor for postoperative pneumonia (odds ratio 3.27, 95% confidence interval 1.50 to 7.12). The other predictors were prior chest surgery, smoking, and thoracotomy incision. There were 4 minor complications related to the retrograde tube (wound infection n=1, broken tube requiring endoscopy n=2, tube caught in anastomosis detected intraoperatively n=1).
  
  
  CONCLUSIONS
  Retrograde gastrostomy decompression of the conduit after esophagectomy is effective and diminishes complications compared with NG tube drainage.
authors.affiliation: Department of Surgery, Washington University School of Medicine, and Barnes Jewish Hospital, St. Louis, Missouri 63110, USA. puriv@wudosis.wustl.edu
authors.forename: Varun
authors.initials: V
authors.lastname: Puri
authors.forename: Yinin
authors.initials: Y
authors.lastname: Hu
authors.forename: Tracey
authors.initials: T
authors.lastname: Guthrie
authors.forename: Traves D
authors.initials: TD
authors.lastname: Crabtree
authors.forename: Daniel
authors.initials: D
authors.lastname: Kreisel
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Krupnick
authors.forename: G Alexander
authors.initials: GA
authors.lastname: Patterson
authors.forename: Bryan F
authors.initials: BF
authors.lastname: Meyers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods*; D004322:Drainage / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007441:Intubation, Gastrointestinal; D007582:Jejunostomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D053120:Respiratory Aspiration / Q000209:etiology / Q000517:prevention & control; D012131:Respiratory Insufficiency / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors