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Background <p>Our team pioneered the use of a joint nasogastric tube (JNT) for pairing overlap-esophagojejunostomy guiding tube (OGT) in an OGT-overlap esophagojejunostomy, demonstrating its safety and efficacy.</p> Objective <p>We&#xa0;aimed&#xa0;to compare the safety and&#xa0;efficacy&#xa0;of&#xa0;a novel technique, the JNT, with traditional nasogastric&#xa0;tubing&#xa0;(TNT)&#xa0;in&#xa0;guiding&#xa0;OGT-overlap esophagojejunostomy.</p> Methods <p>From January 2023 to January 2024, a total of 108 gastric/gastroesophageal junction (G/GEJ) cancer patients undergoing laparoscopic total gastrectomy (LTG) were eligible for inclusion in this study; however, 2 patients were excluded as they underwent hyperthermic intraperitoneal chemotherapy (HIPEC) after surgery. Patients were randomized into two groups: the JNT-OGT-overlap esophagojejunostomy group (JNT group; <i>n</i>&#xa0;=&#xa0;53) or the TNT-OGT-overlap esophagojejunostomy group (TNT group; <i>n</i>&#xa0;=&#xa0;53).</p> Results <p>The JNT&#xa0;group&#xa0;had&#xa0;a&#xa0;significantly&#xa0;higher&#xa0;success rate for&#xa0;nasogastric tube (NT) insertion into the&#xa0;esophageal&#xa0;stump&#xa0;on&#xa0;the&#xa0;first attempt&#xa0;(90.6% vs. 58.5%; <i>p</i>&#xa0;&lt;&#xa0;0.001).&#xa0;Additionally, the insertion times were&#xa0;reduced by 6/7 of their original duration&#xa0;(15 [21] vs. 100 [120]&#xa0;sec; <i>p</i>&#xa0;&lt;&#xa0;0.001)], and connection times for OGT and NT were shortened to 2/5 of their original duration&#xa0;(90 [63] vs. 220 [130]&#xa0;sec; <i>p</i>&#xa0;&lt;&#xa0;0.001). Esophagojejunostomy time was also shorter in the JNT group (17.4 vs. 21.7 min; <i>p</i>&#xa0;&lt;&#xa0;0.001). Two cases were converted from TNT to JNT&#xa0;due&#xa0;to&#xa0;the failure of TNT&#xa0;to guide the esophageal stump entry hole for more than 5&#xa0;min, which was resolved promptly by the JNT. Postoperative complications (18.9% vs. 20.8%; <i>p</i>&#xa0;=&#xa0;0.807),&#xa0;particularly&#xa0;esophagojejunal anastomotic leakage (EJAL; 5.7% vs. 3.8%; <i>p</i>&#xa0;=1.000), and&#xa0;complication severity classification&#xa0;(<i>p</i>&#xa0;=&#xa0;0.315) were&#xa0;comparable&#xa0;between the&#xa0;two groups.</p> Conclusions <p>The JNT technique significantly and safely improved the efficiency of OGT-overlap esophagojejunostomy compared with TNT, suggesting a well-tolerated and efficient new strategy for esophagojejunostomy.</p>

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Joint Nasogastric Tube Versus Traditional Decompression Nasogastric Tube to Guided OGT-Overlap Esophagojejunostomy in Laparoscopic Total Gastrectomy: A Randomized Controlled Trial

  • 期刊论文

  • 发表日期：

    2025年4月29日

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  • Xinhua Chen,
  • Zhijing Yang,
  • Huilin Huang,
  • Chuanjin Xu,
  • Guoxin Li,
  • Yanfeng Hu,
  • Tian Lin,
  • Jiang Yu

摘要

Background

Our team pioneered the use of a joint nasogastric tube (JNT) for pairing overlap-esophagojejunostomy guiding tube (OGT) in an OGT-overlap esophagojejunostomy, demonstrating its safety and efficacy.

Objective

We aimed to compare the safety and efficacy of a novel technique, the JNT, with traditional nasogastric tubing (TNT) in guiding OGT-overlap esophagojejunostomy.

Methods

From January 2023 to January 2024, a total of 108 gastric/gastroesophageal junction (G/GEJ) cancer patients undergoing laparoscopic total gastrectomy (LTG) were eligible for inclusion in this study; however, 2 patients were excluded as they underwent hyperthermic intraperitoneal chemotherapy (HIPEC) after surgery. Patients were randomized into two groups: the JNT-OGT-overlap esophagojejunostomy group (JNT group; n = 53) or the TNT-OGT-overlap esophagojejunostomy group (TNT group; n = 53).

Results

The JNT group had a significantly higher success rate for nasogastric tube (NT) insertion into the esophageal stump on the first attempt (90.6% vs. 58.5%; p < 0.001). Additionally, the insertion times were reduced by 6/7 of their original duration (15 [21] vs. 100 [120] sec; p < 0.001)], and connection times for OGT and NT were shortened to 2/5 of their original duration (90 [63] vs. 220 [130] sec; p < 0.001). Esophagojejunostomy time was also shorter in the JNT group (17.4 vs. 21.7 min; p < 0.001). Two cases were converted from TNT to JNT due to the failure of TNT to guide the esophageal stump entry hole for more than 5 min, which was resolved promptly by the JNT. Postoperative complications (18.9% vs. 20.8%; p = 0.807), particularly esophagojejunal anastomotic leakage (EJAL; 5.7% vs. 3.8%; p =1.000), and complication severity classification (p = 0.315) were comparable between the two groups.

Conclusions

The JNT technique significantly and safely improved the efficiency of OGT-overlap esophagojejunostomy compared with TNT, suggesting a well-tolerated and efficient new strategy for esophagojejunostomy.