Risks and Benefits of Feeding Enterostomy Creation During Minimally Invasive Esophagectomy: A Propensity-Weighted Analysis Using the Japanese National Clinical Database

Ann Gastroenterol Surg. 2026 Mar 17;10(4):1042-1050. doi: 10.1002/ags3.70216. eCollection 2026 Jul.

ABSTRACT

BACKGROUND: Feeding enterostomy is commonly created during minimally invasive esophagectomy (MIE); however, its short-term impact remains unclear.

METHODS: We analyzed 19 054 patients who underwent MIE for esophageal or esophagogastric junction cancer during 2019-2022. Inverse probability of treatment weighting was applied to balance baseline characteristics, and G-computation was used to estimate adjusted risks and means and their differences. A secondary analysis was performed to compare gastrostomy and jejunostomy in retrosternal cases.

RESULTS: Of 19 054 patients, 4599 (24.1%) received a feeding enterostomy. After adjustment, the primary outcome, postoperative bowel obstruction, did not differ significantly between enterostomy group and no-enterostomy group (+0.2%, p = 0.132). The enterostomy group demonstrated higher rates of reoperation (+2.5%, p < 0.001) and respiratory complications, including pneumonia (+2.5%, p < 0.001) and prolonged ventilation (+0.9%, p = 0.012), than the no-enterostomy group. Conversely, delayed gastric emptying (-0.9%, p < 0.001) and deep vein thrombosis (-0.4%, p = 0.028) occurred less frequently. Among 2723 patients who underwent retrosternal reconstruction with feeding enterostomy, jejunostomy was associated with a shorter operative time (-11.2 min, p = 0.025), whereas gastrostomy was associated with a 2.3-day shorter hospital stay than jejunostomy (p = 0.022). Bowel-related events were rare, and adjusted comparisons for these outcomes were not performed.

CONCLUSION: Feeding enterostomy during MIE may confer benefits (e.g., reduced delayed gastric emptying and deep vein thrombosis) but is also associated with increased postoperative complications. Routine or uniform placement of a feeding enterostomy should be avoided, and gastrostomy may be preferable in retrosternal reconstruction.

PMID:42395118 | PMC:PMC13326818 | DOI:10.1002/ags3.70216