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Comparison of Preoperative CT Colonography and Colonoscopy for Esophageal Reconstruction with Colonic Interposition

Comparison of Preoperative CT Colonography and Colonoscopy for Esophageal Reconstruction with... Hindawi Surgery Research and Practice Volume 2020, Article ID 6585762, 5 pages https://doi.org/10.1155/2020/6585762 Research Article Comparison of Preoperative CT Colonography and Colonoscopy for Esophageal Reconstruction with Colonic Interposition Prasit Mahawongkajit and Nuttorn Boochangkool Department of Surgery, Faculty of Medicine, ammasat University, Bangkok, Pathumthani, ailand Correspondence should be addressed to Prasit Mahawongkajit; prasit_md@yahoo.com Received 19 June 2020; Revised 3 November 2020; Accepted 7 November 2020; Published 17 November 2020 Academic Editor: Cosimo Sperti Copyright © 2020 Prasit Mahawongkajit and Nuttorn Boochangkool. -is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Colonic evaluation is an essential step before proceeding with esophagectomy to reconstruct by colonic interposition. Colo- noscopy is the standard practice for colorectal cancer screening, but it has a chance of failing cecal intubation and carries a risk of horrific adverse events by colonic perforation. CT colonography is a less invasive alternative method reported as useful for colonoscopic screening in cases of average risk of colorectal cancer. -is study set out to report our clinical experience and to evaluate CT colonography in the preoperative process for colonic interposition of esophagectomy patients. Data for esoph- agectomy with colonic interposition patients were retrospectively analyzed and compared the colonoscopy group with the CT colonography group. During eight years, 31 patients, 12 patients in the colonoscopy group and 19 patients in the CTcolonography group, included in this study. In both groups, the patient demographic data, procedures, and outcomes were not different. After colonic interposition, endoscopy was performed, and no lesions of conduits were detected. CT colonography is a minimally invasive and reliable option for colonic evaluation method for the patient of average colorectal cancer risk who has undergone esophagectomy with colonic interposition. colonography is a less invasive alternative method reported 1. Introduction to be useful for colonoscopic screening in cases of average Two esophageal diseases, namely, esophageal cancer and risk of colorectal cancer [17, 18]. -is study aimed to report corrosive esophageal injury, are significant health problems our clinical experience and to evaluate CT colonography in worldwide, especially in developing countries such as -ai- the preoperative process for colonic interposition of land [1–6]. Esophagectomy is the leading surgical procedure esophagectomy patients. in many accepted cancer treatment guidelines [7–9], for corrosive esophageal stricture and esophageal perforation 2. Patients/Materials and Methods [10, 11]. Colonic interposition is one of the reconstruction options after esophagectomy for these conditions [12, 13]. We conducted a retrospective study with the esophagectomy Colonic evaluation is an essential step before proceeding patients between January 2011 and December 2019, who with esophagectomy to reconstruct by colonic interposition, were identified in our hospital electronic documentation particularly in a patient who has a high risk for colorectal system. -is study passed the institutional review board and cancer or is more than 50 years old. Colonoscopy is the ethical research process from the Human Ethics Committee standard practice for colorectal cancer screening by direct of -ammasat University (Faculty of Medicine) with ref- visualization of the intraluminal mucosa. However, it has a erence number MTU-EC-SU-0-175/62. chance of failing cecal intubation [14, 15] and carries the risk In this study, the esophageal cancer patients were of horrific adverse events by colonic perforation [16]. CT treated, and the indication of esophagectomy was made by 2 Surgery Research and Practice Table 1: Classification of surgical complications (Clavien–Dindo classification). Grade Definition Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic, and radiological interventions Allowed therapeutic regimens are drugs as antiemetics, antipyretics, analgetics, diuretics, electrolytes, and physiotherapy. -is grade also includes wound infections opened at the bedside. Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included. 3 Requiring surgical, endoscopic, or radiological intervention 3a Intervention not under general anesthesia 3b Intervention under general anesthesia 4 Life-threatening complication (including CNS complications) requiring IC/ICU-management 4a Single organ dysfunction (including dialysis) 4b Multiorgan dysfunction 5 Death of a patient Brain hemorrhage, ischemic stroke, subarachnoid bleeding, but excluding transient ischemic attacks (TIA); IC: intermediate care; ICU: intensive care unit. the gastrointestinal tumor board, which had the treating -e mean age, gender, and indication were not different oncologists, diagnostic radiologists, radiation oncologists, between the two groups. -e greater part of procedural and upper gastrointestinal surgeons as members. indications was neoadjuvant, followed by esophagectomy. For corrosive injury in our study, the surgical candidate Additional demographic data are shown in Table 2. patients consisted of a perforated caustic injury with the -e adverse events and the results by the Clavien–Dindo previous esophagectomy, and postcorrosive stricture with classification of colonoscopy and CT colonography were not unsuccessful esophageal dilation. -is group of patients different. -e surgical operations and outcomes were not obtained nutritional support by feeding jejunostomy and different by the type of conduits, microvascular super- underwent the operation after the corrosive ingestion epi- charging, reconstruction routes, and adverse events. -e sode within a period of 6 to 8 months. majority of conduits used ileocolonic graft. All of the pro- -e surgical plan for the conduit and reconstruction cedures included anastomosis in the left cervical area. Mi- route was made by the patients and their families with an crovascular supercharging was performed in 25% cases of upper gastrointestinal surgeon. -e patients who received a the colonoscopy group and 47.4% cases of the CT colo- gastric tube, whole stomach, and jejunal graft for recon- nography group. Postoperative adverse events were minor struction after esophagectomy and patients with a high risk leakage, anastomotic stricture, and pneumonia without of colorectal cancer were excluded from this study. -e high colonic conduit necrosis, surgical site infection, and 30-day risk of colorectal cancer can be defined as a history of ad- mortality in both groups. After colonic interposition, en- enoma or sessile serrated polyps or colorectal cancer; with a doscopic examination detected no lesions of conduits. history of inflammatory bowel disease; or with a family Additional surgical procedures and outcomes of colonic history of colorectal cancer or confirmed advanced ade- interposition are shown in Table 3. nomas such as high-grade dysplasia, size >1 cm, villous or tubulovillous histology, or advanced sessile serrated polyps 4. Discussion [19]. All of the patients who desired surgery with colonic interposition were assessed by preoperative colonoscopy or Esophagectomy is one of the most invasive surgical pro- CT colonography for colonic evaluation and returned a cedures in gastrointestinal surgery. -e reconstruction op- negative finding of the colon. After surgery, endoscopy was eration is challenging for this group of patients. -e surgeon performed for colonic conduit evaluation within three has optional organs for reconstruction, such as the stomach, months. -e data recorded patient characteristics, surgical colon, and jejunum. -e stomach used as a gastric tube or procedures, postoperative courses, outcomes, and adverse whole stomach is the most prevalent esophageal recon- events with severity by the Clavien–Dindo classification struction conduit. However, for corrosive ingestion, some (Table 1) [20, 21]. -e collected data were analyzed and patients also have a gastric injury, especially for patients with presented descriptively using SPSS version 25 (SPSS Inc, a high grade of corrosive damage, and the addition of such Chicago, USA). an unexpected intraoperative situation, if the gastric conduit is not suitable, makes colon interposition play an essential role. 3. Results -e colonic interposition could be performed by the left side, right side, and ileocolonic graft as the options for During eight years, -irty-one patients who were informed esophagectomy patients [3, 12, 22–24]. Whatever the re- of colonic interposition procedures and consented to un- construction, the quality of the colon should not be dis- dergo surgery included in this study with 12 patients in the regarded. Preoperative colonic evaluation is the crucial step colonoscopy group and 19 patients in the CT colonography in providing intraluminal mucosal information for the group. surgeon who is responsible for performing reconstruction Surgery Research and Practice 3 Table 2: Characteristics of patients treated by colonic interposition. Colonoscopy CT colonoscopy p value Procedure, n n � 12 n � 19 Age, mean± SD, years 51.2± 15 57.6± 13.6 0.24 Sex, male/female 8/3 17/2 0.17 Indication, n (%) Esophageal cancer Neoadjuvant 7 (58.3) 10 (52.6) 0.77 Salvage 2 (16.7) 3 (15.8) 0.95 Corrosive esophageal injury Stricture 1 (8.3) 3 (15.8) 0.95 Perforation 2 (16.7) 3 (15.8) 0.77 Table 3: Procedures and outcomes of colonic interposition. Colonoscopy CT colonography p value Procedure, n n � 12 n � 19 Adverse events, n (%) Oxygen desaturation 0 (0) 2 (0) 0.17 Perforation 0 (0) 0 (0) 0 Conduit, n (%) Left side colon 2 (16.7) 1 (5.3) 0.37 Right side colon 2 (16.7) 2 (10.5) 0.65 Ileocolonic 8 (66.6) 16 (84.2) 0.3 Supercharge, n (%) 3 (25) 9 (47.4) 0.21 Route, n (%) Substernal 8 (66.6) 10 (52.6) 0.45 Subcutaneous 2 (16.7) 9 (47.4) 0.07 Posterior mediastinum 2 (16.7) 0 (0) 0.17 Surgical adverse events, n (%) Leakage 2 (16.7) 2 (10.5) 0.65 Necrosis 0 (0) 0 (0) 0 Stricture 2 (16.7) 2 (10.5) 0.65 Pneumonia 3 (25) 3 (15.8) 0.56 Surgical site infection 0 (0) 0 (0) 0 Classification of surgical complications (Clavien–Dindo classification), n (%) Grade 1 2 (16.7) 2 (10.5) 0.65 Grade 2 1 (8.3) 1 (5.3) 0.76 Grade 3 Grade 3a 2 (16.7) 2 (10.5) 0.65 Grade 3b 0 (0) 0 (0) 0 Grade 4 Grade 4a 2 (16.7) 1 (5.3) 0.37 Grade 4b 0 (0) 0 (0) 0 Grade 5 0 (0) 0 (0) 0 30-day mortality 0 (0) 0 (0) 0 Detected lesion of colonic conduit from endoscopy 0 (0) 0 (0) 0 operations upon this group of patients. -e literature reports and ileocolonic graft of this operation. Although the colo- preoperative investigation for colonic interposition being noscopy group participants did not demonstrate the dif- done by colonoscopy and barium enema [12, 23, 24]. CT ference in adverse events, two patients had oxygen colonography is a minimally invasive technique for colonic desaturation during colonoscopy under intravenous seda- screening while avoiding the perforation risk from the co- tion. All patients were treated successfully by oxygen via a lonoscopy procedure and unsuccessful cecal intubation. -e nasal catheter with close vital signs monitor. In our study, we concerns around unexpected perforation from colonoscopy, applied preoperative CT colonography for the patients who if it happens in an esophageal cancer patient, are that not were not at high risk of colorectal cancer, and the results only patient suffering is increased but also the operation demonstrated it to be safe and effective for assessing the might also be delayed and might affect the treatment out- colon before colonic interposition. Endoscopy was per- come. Also, to complete colonoscopy, especially cecal in- formed in all cases after surgery within three months and tubation, it is necessary to gain information for the right side could not identify mucosal abnormality of conduit that 4 Surgery Research and Practice [2] C. Havanond, “Clinical features of corrosive ingestion,” correlated with the result of preoperative CT colonography. Journal of the Medical Association of ailand�Chotmaihet For postoperative adverse events, previous studies including angphaet, vol. 86, no. 10, pp. 918–924, 2003. a larger number of patients reported anastomosis leakage, [3] S. Awsakulsutthi and C. Havanond, “A retrospective study of 3–35%; conduit necrosis, 0–9%; anastomotic stricture, anastomotic leakage between patients with and without 6–19%; wound infection, 15.8–21%; pulmonary adverse vascular enhancement of esophageal reconstructions with events, 32.6–37%; and 30-day mortality, 2.1–7.8% colon interposition: -ammasat University Hospital experi- [3, 12, 22, 24]. Our study had comparable results of leakage ence,” Asian Journal of Surgery, vol. 38, no. 3, pp. 145–149, and stricture with fewer pulmonary adverse events. -e minor leakage patients were treated conservatively by [4] C. Havanond and P. Havanond, “Initial signs and symptoms feeding jejunostomy as nutritional support and closed as prognostic indicators of severe gastrointestinal tract injury within two weeks after diagnosis. -e leakage patients had due to corrosive ingestion,” e Journal of Emergency Med- become stricture and handled by balloon dilation. All of the icine, vol. 33, no. 4, pp. 349–353, 2007. [5] C. Havanond, “Is there a difference between the management patients with pneumonia prescribed an intravenous broad- of grade 2b and 3 corrosive gastric injuries?” Journal of thr spectrum antibiotic. Two patients in the colonoscopy group Medical Association of ailand�Chotmaihet angphaet, and one in the CT colonography group required respiratory vol. 85, no. 3, pp. 340–344, 2002. support. We did not find conduit necrosis, surgical site [6] P. Mahawongkajit, P. Tomtitchong, N. Boochangkool et al., infection, and 30-day mortality in this study. However, any “Risk factors for esophageal stricture in grade 2b and 3a claims to be better or any clear conclusion cannot be made corrosive esophageal injuries,” Journal of Gastrointestinal because of the small number of patients. Surgery, vol. 22, no. 10, pp. 1659–1664, 2018 Oct. In this study, CT colonography is a minimally invasive [7] National Comprehensive Cancer Network, NCCN Clinical and reliable option for colonic evaluation method for the Practice Guidelines in Oncology: Esophageal and Esoph- patient of average colorectal cancer risk who has undergone agogastric Junction Cancers, National Comprehensive Cancer esophagectomy with colonic interposition. Further large Network, Fort Washington, PA, USA, 2019, https://www. patient number studies with mid- and long-term follow-up, nccn.org/professionals/physician_gls/PDF/esophageal.pdf. [8] Y. Kitagawa, T. Uno, T. Oyama et al., “Esophageal cancer including subsequent endoscopy, are required to assess and practice guidelines 2017 edited by the Japan esophageal so- confirm this situation. We support preoperative CT colo- ciety: part 1,” Esophagus, vol. 16, no. 1, pp. 1–24, 2019. nography as an option in patients who are surgical candi- [9] Y. Kitagawa, T. Uno, T. Oyama et al., “Esophageal cancer dates for esophagectomy and colonic interposition. practice guidelines 2017 edited by the Japan esophageal so- ciety: part 2,” Esophagus, vol. 16, no. 1, pp. 25–43, 2019. Data Availability [10] A. Harlak, T. Yigit, K. Coskun et al., “Surgical treatment of caustic esophageal strictures in adults,” International Journal -e patient data used to support the findings of this study are of Surgery, vol. 11, no. 2, pp. 164–168, 2013. restricted by the Human Ethics Committee of -ammasat [11] X. Dray and P. Cattan, “Foreign bodies and caustic lesions,” University (Faculty of Medicine) in order to protect patient Best Practice & Research Clinical Gastroenterology, vol. 27, privacy. Data are available from Prasit Mahawongkajit no. 5, pp. 679–689, 2013. [12] J. Brown, W. G. Lewis, A. Foliaki, G. W. B. Clark, (prasit_md@yahoo.com) for researchers who meet the cri- G. R. J. C. Blackshaw, and D. S. Y. Chan, “Colonic inter- teria for access to confidential data. position after adult oesophagectomy: systematic review and meta-analysis of conduit choice and outcome,” Journal of Conflicts of Interest Gastrointestinal Surgery, vol. 22, no. 6, pp. 1104–1111, 2018. [13] R. A. Fisher, J. Gossage, and E. Griffiths, “Response to: -e authors declare no conflicts of interest. “colonic interposition after adult oesophagectomy: systematic review and meta-analysis of conduit choice and outcome”,” Authors’ Contributions Journal of Gastrointestinal Surgery, vol. 22, no. 11, p. 2002, Both the authors followed and met the 4 criteria the [14] F. Aslinia, L. Uradomo, A. Steele, B. D. Greenwald, and guidelines of the International Committee of Medical J.-P. Raufman, “Quality assessment of colonoscopic cecal Journal Editors (ICMJE). intubation: an analysis of 6 years of continuous practice at a university hospital,” e American Journal of Gastroenterol- Acknowledgments ogy, vol. 101, no. 4, pp. 721–731, 2006. [15] H. J. Park, J. H. Hong, H. S. Kim et al., “Predictive factors Special thanks are due to Norman Mangnall for assistance in affecting cecal intubation failure in colonoscopy trainees,” editing the English version of this manuscript. BMC Medical Education, vol. 13, p. 5, 2013. [16] V. Rai and N. Mishra, “Colonoscopic perforations,” Clinics in Colon and Rectal Surgery, vol. 31, no. 1, pp. 41–46, 2018. References [17] J. E. Mart´ın-Lopez, ´ C. Beltran-Calvo, ´ R. Rodr´ıguez-Lopez, ´ [1] F. Bray, J. Ferlay, I. Soerjomataram, R. L. Siegel, L. A. Torre, and T. Molina-Lopez, ´ “Comparison of the accuracy of CT colonography and colonoscopy in the diagnosis of colorectal and A. Jemal, “Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers cancer,” Colorectal Disease, vol. 16, no. 3, pp. O82–O89, 2014. [18] J. E. G. IJspeert, C. J. T. Nolthenius, E. J. Kuipers et al., “CT- in 185 countries,” CA: A Cancer Journal for Clinicians, vol. 68, no. 6, pp. 394–424, 2018. colonography vs. colonoscopy for detection of high-risk Surgery Research and Practice 5 sessile serrated polyps,” American Journal of Gastroenterology, vol. 111, no. 4, pp. 516–522, 2016. [19] National Comprehensive Cancer Network, NCCN Clinical Practice Guidelines in Oncology: Colorectal Cancer Screening, National Comprehensive Cancer Network, version 2[Internet], Fort Washington, PA, USA, 2020, https://www.nccn.org/ professionals/physician_gls/pdf/colorectal_screening.pdf. [20] D. Dindo, N. Demartines, and P.-A. Clavien, “Classification of surgical complications,” Annals of Surgery, vol. 240, no. 2, pp. 205–213, 2004. [21] P. A. Clavien, J. Barkun, M. L. de Oliveira et al., “-e clavien- dindo classification of surgical complications,” Annals of Surgery, vol. 250, no. 2, pp. 187–196, 2009. [22] S. Mine, H. Udagawa, K. Tsutsumi et al., “Colon interposition after esophagectomy with extended lymphadenectomy for esophageal cancer,” e Annals of oracic Surgery, vol. 88, no. 5, pp. 1647–1653, 2009. [23] A. Bakshi, D. J. Sugarbaker, and B. M. Burt, “Alternative conduits for esophageal replacement,” Annals of Cardiotho- racic Surgery, vol. 6, no. 2, pp. 137–143, 2017. [24] C. D. Klink, M. Binnebosel, ¨ M. Schneider, K. Ophoff, V. Schumpelick, and M. Jansen, “Operative outcome of colon interposition in the treatment of esophageal cancer: a 20-year experience,” Surgery, vol. 147, no. 4, pp. 491–496, 2010. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Surgery Research and Practice Hindawi Publishing Corporation

Comparison of Preoperative CT Colonography and Colonoscopy for Esophageal Reconstruction with Colonic Interposition

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Copyright © 2020 Prasit Mahawongkajit and Nuttorn Boochangkool. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Hindawi Surgery Research and Practice Volume 2020, Article ID 6585762, 5 pages https://doi.org/10.1155/2020/6585762 Research Article Comparison of Preoperative CT Colonography and Colonoscopy for Esophageal Reconstruction with Colonic Interposition Prasit Mahawongkajit and Nuttorn Boochangkool Department of Surgery, Faculty of Medicine, ammasat University, Bangkok, Pathumthani, ailand Correspondence should be addressed to Prasit Mahawongkajit; prasit_md@yahoo.com Received 19 June 2020; Revised 3 November 2020; Accepted 7 November 2020; Published 17 November 2020 Academic Editor: Cosimo Sperti Copyright © 2020 Prasit Mahawongkajit and Nuttorn Boochangkool. -is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Colonic evaluation is an essential step before proceeding with esophagectomy to reconstruct by colonic interposition. Colo- noscopy is the standard practice for colorectal cancer screening, but it has a chance of failing cecal intubation and carries a risk of horrific adverse events by colonic perforation. CT colonography is a less invasive alternative method reported as useful for colonoscopic screening in cases of average risk of colorectal cancer. -is study set out to report our clinical experience and to evaluate CT colonography in the preoperative process for colonic interposition of esophagectomy patients. Data for esoph- agectomy with colonic interposition patients were retrospectively analyzed and compared the colonoscopy group with the CT colonography group. During eight years, 31 patients, 12 patients in the colonoscopy group and 19 patients in the CTcolonography group, included in this study. In both groups, the patient demographic data, procedures, and outcomes were not different. After colonic interposition, endoscopy was performed, and no lesions of conduits were detected. CT colonography is a minimally invasive and reliable option for colonic evaluation method for the patient of average colorectal cancer risk who has undergone esophagectomy with colonic interposition. colonography is a less invasive alternative method reported 1. Introduction to be useful for colonoscopic screening in cases of average Two esophageal diseases, namely, esophageal cancer and risk of colorectal cancer [17, 18]. -is study aimed to report corrosive esophageal injury, are significant health problems our clinical experience and to evaluate CT colonography in worldwide, especially in developing countries such as -ai- the preoperative process for colonic interposition of land [1–6]. Esophagectomy is the leading surgical procedure esophagectomy patients. in many accepted cancer treatment guidelines [7–9], for corrosive esophageal stricture and esophageal perforation 2. Patients/Materials and Methods [10, 11]. Colonic interposition is one of the reconstruction options after esophagectomy for these conditions [12, 13]. We conducted a retrospective study with the esophagectomy Colonic evaluation is an essential step before proceeding patients between January 2011 and December 2019, who with esophagectomy to reconstruct by colonic interposition, were identified in our hospital electronic documentation particularly in a patient who has a high risk for colorectal system. -is study passed the institutional review board and cancer or is more than 50 years old. Colonoscopy is the ethical research process from the Human Ethics Committee standard practice for colorectal cancer screening by direct of -ammasat University (Faculty of Medicine) with ref- visualization of the intraluminal mucosa. However, it has a erence number MTU-EC-SU-0-175/62. chance of failing cecal intubation [14, 15] and carries the risk In this study, the esophageal cancer patients were of horrific adverse events by colonic perforation [16]. CT treated, and the indication of esophagectomy was made by 2 Surgery Research and Practice Table 1: Classification of surgical complications (Clavien–Dindo classification). Grade Definition Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic, and radiological interventions Allowed therapeutic regimens are drugs as antiemetics, antipyretics, analgetics, diuretics, electrolytes, and physiotherapy. -is grade also includes wound infections opened at the bedside. Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included. 3 Requiring surgical, endoscopic, or radiological intervention 3a Intervention not under general anesthesia 3b Intervention under general anesthesia 4 Life-threatening complication (including CNS complications) requiring IC/ICU-management 4a Single organ dysfunction (including dialysis) 4b Multiorgan dysfunction 5 Death of a patient Brain hemorrhage, ischemic stroke, subarachnoid bleeding, but excluding transient ischemic attacks (TIA); IC: intermediate care; ICU: intensive care unit. the gastrointestinal tumor board, which had the treating -e mean age, gender, and indication were not different oncologists, diagnostic radiologists, radiation oncologists, between the two groups. -e greater part of procedural and upper gastrointestinal surgeons as members. indications was neoadjuvant, followed by esophagectomy. For corrosive injury in our study, the surgical candidate Additional demographic data are shown in Table 2. patients consisted of a perforated caustic injury with the -e adverse events and the results by the Clavien–Dindo previous esophagectomy, and postcorrosive stricture with classification of colonoscopy and CT colonography were not unsuccessful esophageal dilation. -is group of patients different. -e surgical operations and outcomes were not obtained nutritional support by feeding jejunostomy and different by the type of conduits, microvascular super- underwent the operation after the corrosive ingestion epi- charging, reconstruction routes, and adverse events. -e sode within a period of 6 to 8 months. majority of conduits used ileocolonic graft. All of the pro- -e surgical plan for the conduit and reconstruction cedures included anastomosis in the left cervical area. Mi- route was made by the patients and their families with an crovascular supercharging was performed in 25% cases of upper gastrointestinal surgeon. -e patients who received a the colonoscopy group and 47.4% cases of the CT colo- gastric tube, whole stomach, and jejunal graft for recon- nography group. Postoperative adverse events were minor struction after esophagectomy and patients with a high risk leakage, anastomotic stricture, and pneumonia without of colorectal cancer were excluded from this study. -e high colonic conduit necrosis, surgical site infection, and 30-day risk of colorectal cancer can be defined as a history of ad- mortality in both groups. After colonic interposition, en- enoma or sessile serrated polyps or colorectal cancer; with a doscopic examination detected no lesions of conduits. history of inflammatory bowel disease; or with a family Additional surgical procedures and outcomes of colonic history of colorectal cancer or confirmed advanced ade- interposition are shown in Table 3. nomas such as high-grade dysplasia, size >1 cm, villous or tubulovillous histology, or advanced sessile serrated polyps 4. Discussion [19]. All of the patients who desired surgery with colonic interposition were assessed by preoperative colonoscopy or Esophagectomy is one of the most invasive surgical pro- CT colonography for colonic evaluation and returned a cedures in gastrointestinal surgery. -e reconstruction op- negative finding of the colon. After surgery, endoscopy was eration is challenging for this group of patients. -e surgeon performed for colonic conduit evaluation within three has optional organs for reconstruction, such as the stomach, months. -e data recorded patient characteristics, surgical colon, and jejunum. -e stomach used as a gastric tube or procedures, postoperative courses, outcomes, and adverse whole stomach is the most prevalent esophageal recon- events with severity by the Clavien–Dindo classification struction conduit. However, for corrosive ingestion, some (Table 1) [20, 21]. -e collected data were analyzed and patients also have a gastric injury, especially for patients with presented descriptively using SPSS version 25 (SPSS Inc, a high grade of corrosive damage, and the addition of such Chicago, USA). an unexpected intraoperative situation, if the gastric conduit is not suitable, makes colon interposition play an essential role. 3. Results -e colonic interposition could be performed by the left side, right side, and ileocolonic graft as the options for During eight years, -irty-one patients who were informed esophagectomy patients [3, 12, 22–24]. Whatever the re- of colonic interposition procedures and consented to un- construction, the quality of the colon should not be dis- dergo surgery included in this study with 12 patients in the regarded. Preoperative colonic evaluation is the crucial step colonoscopy group and 19 patients in the CT colonography in providing intraluminal mucosal information for the group. surgeon who is responsible for performing reconstruction Surgery Research and Practice 3 Table 2: Characteristics of patients treated by colonic interposition. Colonoscopy CT colonoscopy p value Procedure, n n � 12 n � 19 Age, mean± SD, years 51.2± 15 57.6± 13.6 0.24 Sex, male/female 8/3 17/2 0.17 Indication, n (%) Esophageal cancer Neoadjuvant 7 (58.3) 10 (52.6) 0.77 Salvage 2 (16.7) 3 (15.8) 0.95 Corrosive esophageal injury Stricture 1 (8.3) 3 (15.8) 0.95 Perforation 2 (16.7) 3 (15.8) 0.77 Table 3: Procedures and outcomes of colonic interposition. Colonoscopy CT colonography p value Procedure, n n � 12 n � 19 Adverse events, n (%) Oxygen desaturation 0 (0) 2 (0) 0.17 Perforation 0 (0) 0 (0) 0 Conduit, n (%) Left side colon 2 (16.7) 1 (5.3) 0.37 Right side colon 2 (16.7) 2 (10.5) 0.65 Ileocolonic 8 (66.6) 16 (84.2) 0.3 Supercharge, n (%) 3 (25) 9 (47.4) 0.21 Route, n (%) Substernal 8 (66.6) 10 (52.6) 0.45 Subcutaneous 2 (16.7) 9 (47.4) 0.07 Posterior mediastinum 2 (16.7) 0 (0) 0.17 Surgical adverse events, n (%) Leakage 2 (16.7) 2 (10.5) 0.65 Necrosis 0 (0) 0 (0) 0 Stricture 2 (16.7) 2 (10.5) 0.65 Pneumonia 3 (25) 3 (15.8) 0.56 Surgical site infection 0 (0) 0 (0) 0 Classification of surgical complications (Clavien–Dindo classification), n (%) Grade 1 2 (16.7) 2 (10.5) 0.65 Grade 2 1 (8.3) 1 (5.3) 0.76 Grade 3 Grade 3a 2 (16.7) 2 (10.5) 0.65 Grade 3b 0 (0) 0 (0) 0 Grade 4 Grade 4a 2 (16.7) 1 (5.3) 0.37 Grade 4b 0 (0) 0 (0) 0 Grade 5 0 (0) 0 (0) 0 30-day mortality 0 (0) 0 (0) 0 Detected lesion of colonic conduit from endoscopy 0 (0) 0 (0) 0 operations upon this group of patients. -e literature reports and ileocolonic graft of this operation. Although the colo- preoperative investigation for colonic interposition being noscopy group participants did not demonstrate the dif- done by colonoscopy and barium enema [12, 23, 24]. CT ference in adverse events, two patients had oxygen colonography is a minimally invasive technique for colonic desaturation during colonoscopy under intravenous seda- screening while avoiding the perforation risk from the co- tion. All patients were treated successfully by oxygen via a lonoscopy procedure and unsuccessful cecal intubation. -e nasal catheter with close vital signs monitor. In our study, we concerns around unexpected perforation from colonoscopy, applied preoperative CT colonography for the patients who if it happens in an esophageal cancer patient, are that not were not at high risk of colorectal cancer, and the results only patient suffering is increased but also the operation demonstrated it to be safe and effective for assessing the might also be delayed and might affect the treatment out- colon before colonic interposition. Endoscopy was per- come. Also, to complete colonoscopy, especially cecal in- formed in all cases after surgery within three months and tubation, it is necessary to gain information for the right side could not identify mucosal abnormality of conduit that 4 Surgery Research and Practice [2] C. Havanond, “Clinical features of corrosive ingestion,” correlated with the result of preoperative CT colonography. Journal of the Medical Association of ailand�Chotmaihet For postoperative adverse events, previous studies including angphaet, vol. 86, no. 10, pp. 918–924, 2003. a larger number of patients reported anastomosis leakage, [3] S. Awsakulsutthi and C. Havanond, “A retrospective study of 3–35%; conduit necrosis, 0–9%; anastomotic stricture, anastomotic leakage between patients with and without 6–19%; wound infection, 15.8–21%; pulmonary adverse vascular enhancement of esophageal reconstructions with events, 32.6–37%; and 30-day mortality, 2.1–7.8% colon interposition: -ammasat University Hospital experi- [3, 12, 22, 24]. Our study had comparable results of leakage ence,” Asian Journal of Surgery, vol. 38, no. 3, pp. 145–149, and stricture with fewer pulmonary adverse events. -e minor leakage patients were treated conservatively by [4] C. Havanond and P. Havanond, “Initial signs and symptoms feeding jejunostomy as nutritional support and closed as prognostic indicators of severe gastrointestinal tract injury within two weeks after diagnosis. -e leakage patients had due to corrosive ingestion,” e Journal of Emergency Med- become stricture and handled by balloon dilation. All of the icine, vol. 33, no. 4, pp. 349–353, 2007. [5] C. Havanond, “Is there a difference between the management patients with pneumonia prescribed an intravenous broad- of grade 2b and 3 corrosive gastric injuries?” Journal of thr spectrum antibiotic. Two patients in the colonoscopy group Medical Association of ailand�Chotmaihet angphaet, and one in the CT colonography group required respiratory vol. 85, no. 3, pp. 340–344, 2002. support. We did not find conduit necrosis, surgical site [6] P. Mahawongkajit, P. Tomtitchong, N. Boochangkool et al., infection, and 30-day mortality in this study. However, any “Risk factors for esophageal stricture in grade 2b and 3a claims to be better or any clear conclusion cannot be made corrosive esophageal injuries,” Journal of Gastrointestinal because of the small number of patients. Surgery, vol. 22, no. 10, pp. 1659–1664, 2018 Oct. In this study, CT colonography is a minimally invasive [7] National Comprehensive Cancer Network, NCCN Clinical and reliable option for colonic evaluation method for the Practice Guidelines in Oncology: Esophageal and Esoph- patient of average colorectal cancer risk who has undergone agogastric Junction Cancers, National Comprehensive Cancer esophagectomy with colonic interposition. Further large Network, Fort Washington, PA, USA, 2019, https://www. patient number studies with mid- and long-term follow-up, nccn.org/professionals/physician_gls/PDF/esophageal.pdf. [8] Y. Kitagawa, T. Uno, T. 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Cattan, “Foreign bodies and caustic lesions,” University (Faculty of Medicine) in order to protect patient Best Practice & Research Clinical Gastroenterology, vol. 27, privacy. Data are available from Prasit Mahawongkajit no. 5, pp. 679–689, 2013. [12] J. Brown, W. G. Lewis, A. Foliaki, G. W. B. Clark, (prasit_md@yahoo.com) for researchers who meet the cri- G. R. J. C. Blackshaw, and D. S. Y. Chan, “Colonic inter- teria for access to confidential data. position after adult oesophagectomy: systematic review and meta-analysis of conduit choice and outcome,” Journal of Conflicts of Interest Gastrointestinal Surgery, vol. 22, no. 6, pp. 1104–1111, 2018. [13] R. A. Fisher, J. Gossage, and E. Griffiths, “Response to: -e authors declare no conflicts of interest. “colonic interposition after adult oesophagectomy: systematic review and meta-analysis of conduit choice and outcome”,” Authors’ Contributions Journal of Gastrointestinal Surgery, vol. 22, no. 11, p. 2002, Both the authors followed and met the 4 criteria the [14] F. Aslinia, L. Uradomo, A. Steele, B. D. Greenwald, and guidelines of the International Committee of Medical J.-P. Raufman, “Quality assessment of colonoscopic cecal Journal Editors (ICMJE). intubation: an analysis of 6 years of continuous practice at a university hospital,” e American Journal of Gastroenterol- Acknowledgments ogy, vol. 101, no. 4, pp. 721–731, 2006. [15] H. J. Park, J. H. Hong, H. S. Kim et al., “Predictive factors Special thanks are due to Norman Mangnall for assistance in affecting cecal intubation failure in colonoscopy trainees,” editing the English version of this manuscript. BMC Medical Education, vol. 13, p. 5, 2013. [16] V. 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