Endoscopically Guided Laparoscopic Gastrojejunostomy Tube Placement for Patients with Distal Esophageal Stents.
Patients with distal esophageal pathology such as perforation, trachea-esophageal fistulae, and/ or obstructing gastroesophageal junction tumor present a challenging situation in terms of feeding access where an esophageal stent is placed across the gastroesophageal junction. In order to allow simultaneous gastric decompression and post-pyloric feeds without significant reflux up through the stent, a gastrojejunostomy (GJ) tube is a viable option. We hereby describe a hybrid approach to placing these GJ tubes in this cohort of patients using simultaneous laparoscopy, endoscopy, and fluoroscopy with minimal manipulation of the stent itself. We have employed this technique of placing GJ tubes 2-3 days following placement of the esophageal stent in six consecutive patients. All patients tolerated the procedure well without any complications. Endoscopically guided laparoscopic GJ tubes are ideal for bridging patients, with distal esophageal pathology requiring esophageal stents, to oral intake.
Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Suite 1661, Houston, TX, 77030, USA.
Marlieke E
ME
Nussenbaum
Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Suite 1661, Houston, TX, 77030, USA.
Edward Y
EY
Chan
Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Suite 1661, Houston, TX, 77030, USA.|Weill Cornell Medicine, Houston Methodist Hospital, Houston, TX, USA.
Min P
MP
Kim
Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Suite 1661, Houston, TX, 77030, USA. pgaur@houstonmethodist.org.|Weill Cornell Medicine, Houston Methodist Hospital, Houston, TX, USA. pgaur@houstonmethodist.org.
Puja G
PG
Khaitan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal; D004943:Esophagogastric Junction; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000295:instrumentation / Q000379:methods*; D005764:Gastroesophageal Reflux; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015641:Radiography, Interventional; D015607:Stents
Esophageal perforation; Esophageal stents; Feeding access (gastrojejunostomy tube placement)