Technical notes and outcomes of robot-assisted and laparoscopic jejunostomy placement for tube feeding after esophagectomy

Background: Recent studies reported considerable jejunostomy-related morbidity after esophagectomy, questioning the appropriateness of jejunostomy tube feeding for esophageal cancer patients. This study aimed to describe a technique for (robot-assisted) laparoscopic jejunostomy tube placement and to report its associated outcomes in patients undergoing minimally invasive esophagectomy (MIE). Methods: In this observational cohort study, patients who underwent MIE with (robot-assisted) laparoscopic jejunostomy tube placement were included from the prospective databases of two centers (2010-2019). Main endpoints included the incidence of jejunostomy-related complications, the duration of jejunostomy tube feeding, and weight change between surgery and 3- and 6-month follow-up. Patient characteristics were compared between patients who had jejunostomy-related complications versus patients who did not. Results: Jejunostomy-related complications occurred in 13 out of 93 patients (14%) and all involved infections. No intestinal torsions occurred in this cohort. Re-operation for jejunostomy-related infection was required in 1 patient (1%). Pre-existent comorbidity (100% vs. 71%, P=0.033), and diabetes mellitus in particular (31% vs. 9%, P=0.044), were significantly more common in patients with jejunostomy-related infections compared to patients without such complications. Jejunostomy tubes were removed earlier in patients with jejunostomy-related complications [median day 21 (IQR, 11-61) vs. day 37 (IQR, 28-72), P=0.049]. Conclusions: Minimally invasive jejunostomy tube placement with additional anti-rotation fixation, either robotically or laparoscopically, is a safe and advisable way of establishing the enteral feeding route in patients undergoing MIE

Ablación por radiofrecuencia en esófago de Barrett. Experiencia Inicial

La radiofrecuencia endoscópica utiliza energía térmica para ablacionar la capa superficial del esófago donde se localiza el tejido característico del Esófago de Barrett (EB). Pacientes y métodos. Se incluyeron 50 pacientes adultos con diagnóstico de EB de acuerdo a la clasificación de Viena. Objetivos. Se evaluó la seguridad y la eficacia de la ablación por radio-frecuencia (ARF) en pacientes con EB. Resultados. Fueron tratados 50 pacientes con una mediana de seguimiento de 18 meses. La mediana de edad fue de 58 años. Hasta lograr la erradicación del EB se realizaron 1,4 sesiones de ARF por paciente. La morbilidad del procedimiento fue del 6% y la complicación más frecuente fue la estenosis esofágica (dos casos). No se observó recurrencia de la metaplasia intestinal durante el seguimiento. Conclusiones. En nuestra experiencia la ARF es un procedimiento seguro con baja morbilidad. Los resultados a mediano y largo plazo publicados son estimulantes y permiten comenzar a reevaluar los protocolos de seguimiento vigentes