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Gastric tube ulcer after esophagectomy

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Abstract

Background

An ulcer occasionally develops in the gastric tube as an esophageal substitute after esophagectomy. The aim of the present study was to investigate the risk factors for a gastric tube ulcer.

Methods

We reviewed the medical records of all 826 patients who underwent esophageal reconstruction using a gastric tube following esophagectomy, in Kurume University Hospital between 1985 and 2010. Potential risk factors for a gastric tube ulcer were investigated by comparing the clinical characteristics between patients with a gastric tube ulcer and those without, using a multivariate logistic regression model.

Results

Among the 826 patients, 30 patients (3.6 %) developed a gastric tube ulcer. In 19 cases without any signs or symptoms, the ulcer was found using upper endoscopy. In the other 11 patients, there were symptoms including hematemesis, chest pain, and/or abdominal pain. In 3 cases, the patient developed a severe complication from the ulceration such as perforation. Of these 3 cases, one patient died of massive bleeding from the left brachiocephalic vein. The multivariate analysis revealed that (1) a past history of a peptic ulcer, and (2) the period of treatment (meaning the more recent period after the introduction of systematic prevention and treatment for a gastric tube ulcer) were the only two risk factors for a gastric tube ulcer (p < 0.0001, and p = 0.033, respectively).

Conclusions

Systematic prevention and treatment for a gastric tube ulcer including follow-up endoscopy, proton pump inhibitors administration according to 24-h pH monitoring, eradication of H. pylori, and others may decrease the incidence of a gastric tube ulcer. In particular, for patients with a past history of a peptic ulcer, the subcutaneous route of esophageal reconstruction is recommended to prevent fatal complications.

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Ethical Statement

This article does not contain any studies with human or animal subjects performed by any of the authors.

Conflict of interest

There are no financial or other relations that constitute a conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, Fukuoka, 830-0023, Japan

    Naoki Mori, Hiromasa Fujita, Toshiaki Tanaka, Satoru Matono, Kohei Nishimura, Haruhiro Hino & Kazuo Shirouzu

  2. Biostatistics Center, Kurume University, Kurume city, Fukuoka, 830-0023, Japan

    Shou Komukai & Takashi Yanagawa

Authors
  1. Naoki Mori
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  2. Hiromasa Fujita
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  3. Toshiaki Tanaka
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  4. Satoru Matono
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  5. Kohei Nishimura
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  6. Haruhiro Hino
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  7. Kazuo Shirouzu
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  8. Shou Komukai
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  9. Takashi Yanagawa
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Correspondence to Naoki Mori.

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Mori, N., Fujita, H., Tanaka, T. et al. Gastric tube ulcer after esophagectomy. Esophagus 12, 44–49 (2015). https://doi.org/10.1007/s10388-014-0453-5

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  • DOI: https://doi.org/10.1007/s10388-014-0453-5

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