Timing of percutaneous endoscopic gastrostomy tube placement after cervical esophageal reconstruction with free jejunal transfer.

The timing of percutaneous endoscopic gastrostomy (PEG) tube placement in patients who undergo cervical esophageal reconstruction using free jejunal transfer is controversial. The purpose of this study was to review the authors' experience with pharyngeal reconstruction using free jejunal transfer to establish useful guidelines for enteral tube placement. A retrospective analysis of all patients treated with free jejunal autografts for reconstruction of cervical esophageal defects during a 12-year period was performed. A total of 105 patients underwent 108 esophageal reconstructions using these techniques. Sixty-three patients (60%) did not have enteral tube placement at any time, whereas 42 patients had gastrostomy or PEG tubes placed preoperatively (n = 12), intraoperatively (n = 8), or postoperatively. The majority of patients were able to resume per-oral feeds and avoid long-term tube feeds (86.7%). Most patients who underwent preoperative or intraoperative enteral tube feed placement had them removed postoperatively (82%). Only patients who required postoperative placement of feeding tubes required prolonged feeding tube support. In conclusion, most patients who undergo esophageal reconstruction using free jejunal transfer recover the ability to swallow and maintain adequate nutrition without supplemental enteral tube feeds. Preoperative gastrostomy tube placement is not necessary in most patients unless severe preoperative nutritional compromise is present.