Our Summary

This research paper discusses a rare health problem that can happen after a partial or complete removal of the esophagus (the tube that connects your throat to your stomach). This surgery is often followed by a procedure to rebuild the digestive tract using a part of the stomach, creating what’s known as a gastric tube conduit. Sometimes, this conduit can be too long and floppy, causing difficulty in swallowing in patients who survive for a long time after the surgery. An extremely rare complication of this is called gastric tube volvulus, where this conduit twists upon itself.

The paper presents a case of a 57-year-old man who experienced this problem more than two years after his esophagus removal surgery. The issue was identified using a CT scan and was fixed using a non-surgical procedure where the twist was untwisted using an instrument inserted through the mouth. This is only the fourth case of such a problem reported in English medical literature. The paper suggests that the problem might be due to the conduit being too long and floppy, and serves as evidence that it can be successfully fixed without surgery.

FAQs

  1. What is a gastric tube conduit and why is it used after an esophagectomy?
  2. What is a gastric tube volvulus and how is it diagnosed?
  3. What is the treatment for gastric tube volvulus?

Doctor’s Tip

A helpful tip a doctor might tell a patient about esophagectomy is to be aware of the potential rare complication of gastric tube volvulus. Patients should be mindful of any symptoms such as sudden onset of severe chest or abdominal pain, difficulty swallowing, or vomiting after undergoing an esophagectomy. If any of these symptoms occur, it is important to seek immediate medical attention for proper diagnosis and treatment.

Suitable For

Patients who are typically recommended for esophagectomy include those with esophageal cancer, Barrett’s esophagus with high-grade dysplasia, esophageal strictures that cannot be managed with other treatments, and severe gastroesophageal reflux disease (GERD) that does not respond to medications or other interventions. Other conditions that may require esophagectomy include esophageal perforation, esophageal diverticula, and benign tumors of the esophagus. In some cases, esophagectomy may be recommended as a prophylactic measure for patients with a high risk of developing esophageal cancer, such as those with a history of Barrett’s esophagus or a strong family history of the disease.

Timeline

Before esophagectomy:

  • Patient undergoes various diagnostic tests such as endoscopy, biopsy, CT scans, and PET scans to determine the extent of the cancer and whether surgery is the best treatment option.
  • Patient may undergo chemotherapy and/or radiation therapy to shrink the tumor before surgery.
  • Patient receives pre-operative counseling and preparation for the surgery, including instructions on dietary restrictions and cessation of smoking.

After esophagectomy:

  • Patient undergoes a hospital stay of 7-14 days, during which time they are closely monitored for complications such as infection, leakage from the surgical site, and difficulty swallowing.
  • Patient receives nutrition through a feeding tube or IV fluids until they are able to tolerate a liquid diet and gradually progress to solid foods.
  • Patient undergoes physical therapy to regain strength and mobility after surgery.
  • Patient may experience side effects such as reflux, dumping syndrome, and changes in taste and appetite.
  • Patient is followed up with regular check-ups and imaging studies to monitor for recurrence of cancer.

What to Ask Your Doctor

  1. What are the potential complications of an esophagectomy, including rare complications like gastric tube volvulus?

  2. How common is gastric tube volvulus after an esophagectomy?

  3. What are the symptoms of gastric tube volvulus and how is it diagnosed?

  4. What treatment options are available for gastric tube volvulus?

  5. How can gastric tube volvulus be prevented after an esophagectomy?

  6. How often should I follow up with my healthcare provider after an esophagectomy to monitor for complications like gastric tube volvulus?

  7. Are there any lifestyle changes or dietary modifications I should make to reduce the risk of gastric tube volvulus after surgery?

Reference

Authors: Schizas D, Michalinos A, Vergadis C, Oikonomou D, Baili E, Sougioultzis S, Moris D, Liakakos T. Journal: Ann R Coll Surg Engl. 2019 Jan;101(1):e1-e4. doi: 10.1308/rcsann.2018.0146. Epub 2018 Oct 5. PMID: 30286640