Disorders of the Gastrointestinal System, 2nd Edition
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This procedure can be indicated if a signif- icant amount of tissue is involved. Efforts are made to maintain a passageway for food by connecting the esophagus’s up- per part to the stomach’s remaining part. If this is not possible, it may be necessary for the patient to have a feeding gastros- tomy placed (Swanson, 2022). Postoper- atively, patients require a gastrostomy or jejunostomy tube, intravenous therapy, and supplemental oxygen. The feeding tube remains in place until a normal diet can be resumed and the anastomosis between the esophagus and stomach is healed (Swanson, 2022). Complications from esophagectomy can affect multiple body systems, with an overall mortality rate of up to 22%. Re- cent studies indicate that despite the high complication rate, approximately 86% of patients have an improvement in their symptoms. Frequent complications may include the following (Raymond, 2021): ● Respiratory complications (16%– 67%) : Atelectasis, pleural effusion, pulmonary embolism, acute respiratory distress syndrome, bronchospasm, and pneumonia. ● Cardiac complications : Cardiac arrhythmias (up to 20%) and myocardial infarctions (about 3.8%). ● Surgery-specific complications (up to 40%) : Wound infection, anastomotic leak (a breakdown of the new connection between the stomach and esophagus), stricture, conduit ischemia, laryngeal nerve injury, dysphagia, and gastric symptoms. Chemotherapy and immunotherapy may also be part of the treatment regi- men. Current research indicates that che- motherapy, in combination with radiation therapy, improves outcomes, especially if used before surgery, although chemo-
therapy may be used alone (ACS, 2020b). The most common chemotherapy-in- duced side effects are neutropenia, sto- matitis, mucositis, diarrhea, and emesis. Common side effects of immunotherapy can include fatigue, cough, nausea, skin rash, poor appetite, constipation, muscle or joint pain, itching, fever, and diarrhea. More serious complications of immuno - therapy may include infusion reactions and autoimmune reactions (ACS, 2022b). Radiation therapy, in conjunction with chemotherapy, may be used when sur- gery is not an option. This may be due to the patient’s refusal to undergo surgery or the inability to tolerate surgery due to poor overall health. Radiation may also be palliative in advanced esophageal cancer cases (ACS, 2020b). Potential complications associated with radiation to the esophagus may include (ACS, 2020b): ● Damage to the heart, lungs, or spinal cord. ● Fatigue. ● Skin issues such as radiation burns, compromised healing ability, and pain. ● Esophagitis, which can lead to difficulty with swallowing and result in nutritional deficits that require supplementation. ● Formation of esophageal strictures or shrinkage of the tissue, which leads to difficulty swallowing and may require esophageal dilation. The effects of surgery, radiation, and chemotherapy make patients susceptible to compromised nutritional status and swallowing complications.
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