Endoscopic Evaluation for Predicting the Complications Related to Gastric Conduit After Esophagectomy

Study Overview
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Brief Summary
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Gastric conduit ischemia or anastomotic breakdown after esophagectomy with cervical esophagogastrostomy often cause severe complications, such as leakage, necrotic organs, and strictures. Thus, the purpose of this study is the safety and efficacy of endoscopic evaluation about reconstructive organs after esophagectomy. The investigators evaluate endoscopic predictions using classifications in acute phase after esophagogastrostomy.

Detailed Description
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The development and improvement of thoracoscopic esophagectomy (TE) reduced the severe pulmonary complication after esophagectomy. However, the postoperative complications relative to gastric conduit reconstruction are still common issues after esophagectomy. The ischemia of the proximal portion of the graft predisposes these patients to a high incidence of anastomotic complications after esophagectomy. Less commonly, severe graft ischemia can lead to transmural necrosis. Thus, early diagnosis of ischemic reaction may provide the suitable postoperative management and therapeutic intervention to prevent leakage, strictures and necrosis. Thus, the purpose of this study is the safety and efficacy of endoscopic evaluation about reconstructive organs after esophagectomy. The investigators evaluate endoscopic predictions using classifications in acute phase after esophagogastrostomy.

Official Title
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Endoscopic Evaluation for Predicting the Complications Related to Gastric Conduit After Esophagectomy

Conditions
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Esophageal Neoplasms, Constriction, Anastomotic Leak, Ischemia

Intervention / Treatment
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* Diagnostic Test: Patients after esophagectomy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - Malignant or end-stage benign esophageal disease. Esophagectomy with reconstruction by a gastric pull-up. Exclusion Criteria: - Severe heart failure and pulmonary dysfunction Severe renal and liver dysfunction Allergenic history Pregnancy

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 84 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: Patients after esophagectomy|Endoscopic examinations are performed at 1 and 8 postoperative days. Endoscopic examination is added when abnormal findings are demonstrated.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The classification of gastric conduit ischemia by endoscopic findings predicts the major complications of gastric conduit (strictures, leakage, necrosis) |  | From 1 to 29 days after esophagectomy | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Biological examination of the mucosal biopsy of gastric conduit as assessed by the ischemia related RNA copy number |  | From 1 to 15 days after esophagectomy | 
| Biological examination of the mucosal biopsy of gastric conduit as assessed by the scoring system for immunohistochemical staining | The scoring system refer to the article entitled a scoring system for immunohistochemical staining: consensus report of the task force for basic research of the European Organization for Research and Treatment of Cancer-Gynaecological Cancer Cooperative Group | From 1 to 15 days after esophagectomy | 
| Biological examination of gastric conduit as assessed by the Mitochondrial DNA copy number |  | From 1 to 15 days after esophagectomy |