# A Case Report on the Use of a Novel Technique for Intra-operative Nasojejunal Tube Placement in a Patient Undergoing Ivor-Lewis Esophagectomy

## TL;DR

This case report describes a new method for placing a feeding tube during a specific type of esophagectomy surgery without using traditional imaging techniques.

## Contribution

A novel technique for nasojejunal tube placement during Ivor-Lewis esophagectomy is introduced and described.

## Key findings

- The technique avoids endoscopic or fluoroscopic guidance for NJT placement.
- The method is proposed as a potential alternative to reduce risks associated with traditional feeding methods.
- Further studies are needed to confirm the safety of the technique.

## Abstract

Esophagectomy is an important cornerstone in the management of esophageal cancer. Post-operative feeding options in Ivor-Lewis esophagectomy include nasojejunal tube (NJT), feeding jejunostomy, and direct oral feeding. NJT is traditionally placed endoscopically or under fluoroscopic guidance. In this case report we present an alternate technique for NJT placement.

A 55-year-old male presented to our clinic with dysphagia. On esophagogastroduodenoscopy, a gastroesophageal junction (GOJ) tumor was noted. A diagnosis of moderately differentiated adenocarcinoma was made on biopsy. The patient received eight cycles of epirubicin, cisplatin, and capecitabine (ECX), following which an Ivor-Lewis esophagectomy was carried out. This case report highlights the technical aspects and potential pitfalls of placing NJT in patients undergoing Ivor-Lewis esophagectomy without the use of endoscopy or fluoroscopic guidance.

Direct oral feeding after Ivor-Lewis esophagectomy may lead to suboptimal caloric provision while feeding jejunostomy is associated with complications such as dermatitis, wound infection, and intestinal obstruction. On the other hand, endoscopic or fluoroscopic insertion of NJT can expose the anastomosis to potentially harmful mechanical forces. NJT can be easily placed using our technique in patients undergoing hybrid Ivor-Lewis esophagectomy. The safety of this technique can be investigated by further studies.