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Bull A, Pucher PH, Maynard N, et al. Nasogastric tube drainage and pyloric intervention after oesophageal resection: UK practice variation and effect on outcomes. Eur J Surg Oncol. 2021;doi: 10.1016/j.ejso.2021.11.125.
Bull, A., Pucher, P. H., Maynard, N., Underwood, T. J., Lagergren, J., Gossage, J. A. (2021). Nasogastric tube drainage and pyloric intervention after oesophageal resection: UK practice variation and effect on outcomes. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, . https://doi.org/10.1016/j.ejso.2021.11.125
Bull, Alexander, et al. "Nasogastric tube drainage and pyloric intervention after oesophageal resection: UK practice variation and effect on outcomes." European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology vol. (2021). doi: https://doi.org/10.1016/j.ejso.2021.11.125
Bull A, Pucher PH, Maynard N, Underwood TJ, Lagergren J, Gossage JA. Nasogastric tube drainage and pyloric intervention after oesophageal resection: UK practice variation and effect on outcomes. Eur J Surg Oncol. 2021 Nov 22; doi: 10.1016/j.ejso.2021.11.125. Epub 2021 Nov 22. PMID: 34840008.
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Eur J Surg Oncol. 2021 Nov 22; doi: 10.1016/j.ejso.2021.11.125. Epub 2021 Nov 22.

Nasogastric tube drainage and pyloric intervention after oesophageal resection: UK practice variation and effect on outcomes.

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

Alexander Bull, Philip H Pucher, Nick Maynard, Tim J Underwood, Jesper Lagergren, James A Gossage,

Affiliations

  1. Department of General Surgery, Guy's and St Thomas' NHS Trust, London, UK.
  2. Department of General Surgery, Guy's and St Thomas' NHS Trust, London, UK; Department of General Surgery, Queen Alexandra Hospital, Portsmouth University Hospital NHS Trust, Portsmouth, UK.
  3. Department of General Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK.
  4. School of Cancer Sciences, Faculty of Medicine, University of Southampton, UK.
  5. Department of General Surgery, Guy's and St Thomas' NHS Trust, London, UK; School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
  6. Department of General Surgery, Guy's and St Thomas' NHS Trust, London, UK; School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. Electronic address: [email protected].

PMID: 34840008 DOI: 10.1016/j.ejso.2021.11.125

Abstract

BACKGROUND: Over 1500 patients with oesophageal cancer undergo a resection in the UK each year. At surgery, patients commonly have a nasogastric tube (NGT) placed and may undergo a pyloric intervention. There is conflicting evidence on the use of both NGTs and pyloric interventions during oesophageal resections. We performed a national survey of oesophageal centres and assessed practice variation.

MATERIAL AND METHODS: An electronic survey was distributed to all resection centres in England, Wales and Scotland. Variations in practice regarding NGTs and pyloric intervention were assessed, and compared to nationally reported centre volumes and length-of-stay data.

RESULTS: Most centres (31/39, 79%) responded to the survey. All centres reported routine NGT use. The majority of centres (19/31, 61%) did not perform pyloric interventions. When used, surgical pyloroplasty was the most frequent strategy (8/31, 26%). Routine post-operative radiological assessment was utilised in 9/31 (29%) of centres. Criteria for NGT removal and dietary progression was highly variable, with every centre reporting different protocols. There were no significant differences in practice between high and low volume centres. There were also no trends seen when comparing centres above vs at-or-below the median length-of-stay. The majority (68%) of centres were willing to take part in a trial assessing NGT use and pyloric interventions.

CONCLUSIONS: Pyloric intervention use varies widely, with no clear link to outcomes. NGT use remains standard practice despite evidence for safe omission. Surgeons require and recognise the need for a trial to assess requirement for NGTs and pyloric intervention after oesophageal resection.

Copyright © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Keywords: Delayed gastric emptying; Enhanced recovery; Nasogastric tube; Oesophageal cancer; Oesophagectomy; Pyloric intervention

Conflict of interest statement

Declaration of competing interest The authors whose names are listed immediately below certify that they have no affiliations with or involvement in any organization or entity with any financial inter

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