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Background:
Gastric decompression(GD) after esophagectomy and gastric transposition could drainage the gastric juice and air retented in intrathoracic stomach, thus could prevent the dilation of the stomach, reduce anastomotic tension and extenuate gastroesophageal regurgitation(GER). Theoretically, this could benefit the healing of anastomosis. So GD is routinely used in patients with esophageal cancer after operation. But is GD really necessary? The dilation of intrathoracic stomach could be prevented by gastric tube and a new measure named stomach embedment. Moreover, the postoperative volume of gastric decompression is usually less than 300ml/d, however the volumn of gastric juice production is about 2L/d. We thought this trivial 300ml fluid might won't cause severe GER even it hadn't been drainaged. So GD might be no longer essential for surgical patients with esophageal cancer. The aim of this study is to confirm this presumption.
Methods:
Totally 147 patient were enrolled in this study. All patient received esophagectomy and gastric tube reconstruction. After anastomosis, intrathoracic stomach was embedded into posterior mediastinum with a medical sealant glue. This glue could fix stomach with the organ surround it and therefore can prevent the dilation of the stomach. Patient were randomly divided into GD group and non- gastric decompression group(NGD). Nasogastric tube was inserted in operation for patient in GD group, and removed 4 days after operation. However 4 patients in GD group failed to insert nasogastric tube then be reassigned to NGD group. Finally we got 72 patient in GD group and 75 patient in NGD group.
Indices compared between groups include Overall experience score (OES, with a 1-10 score system on the 3rd day after operation), maximum transverse diameter of intrathoracic stomach(MTD, with CT, at the level of inferior pulmonary vein on the 3rd day after operation), severity of GER(with a GER symptom questionnaire on the 3rd day after operation), the need for insert / reinsert nasogastric tube after operation, the application of stomach dynamic medicine, pneumonia, anastomostic leakage and postoperative hospital stay.
Results:
No difference was found between groups in any index except for the OES. When stratified analysis according surgical incision was performed, the OES in NGD group was significant better than that in GD group(p<0.05). This outcome indicate that GD couldn't extenuate GER, prevent the dilation of the stomach, reduce complication rate, shorten hospital stay. On the contrary, it diminish the short-term postoperative life quality.
Conclusions:
GD is no longer necessary for patient receiving esophagectomy and gastric transposition after the application of gastric tube and stomach embedment. We don't need to consider GD as a routine for patient who is not in high risk of anstomostic leakage.
Indices between groups

	GD group		NGD group		p value
Age	62.2±7.5		64.7±5.9		0.782
Gender (M/F)	66/6		68/7		0.831
Tumor Location (medien/lower)	47/25		52/23		0.725
TNM Staging (0/I/II/III)	3/7/27/35		2/9/31/33		0.859
Overall Experience Score
Sweet procedure group	n=43	6.2±2.6	n=41	7.5±2.4	<0.001
Ivor-Lewis procedure group	n=29	6.1±3.1	n=34	7.2±3.5	0.001
Maximum Transverse Diameter of Intrathoracic Stomach(cm)
Sweet procedure group	n=43	7.5±2.1	n=41	7.7±1.8	0.135
Ivor-Lewis procedure group	n=29	8.1±2.5	n=34	8.2±2.1	0.398
Severity of Gastroesophageal Reflux (0/1/2)
Sweet procedure group	n=43	40/3/0	n=41	38/3/0	1.000
Ivor-Lewis procedure group	n=29	26/3/0	n=34	30 /4/0	1.000
Need for Insert / Reinsert Nasogastric Tube(n)
Sweet procedure group	n=43	1	n=41	0	1.000
Ivor-Lewis procedure group	n=29	2	n=34	1	0.590
Application of Stomach Dynamic Medicine(n)
Sweet procedure group	n=43	5	n=41	6	0.754
Ivor-Lewis procedure group	n=29	5	n=34	5	1.000
Pneumonia (n)
Sweet procedure group	n=43	1	n=41	1	1.000
Ivor-Lewis procedure group	n=29	0	n=34	1	1.000
Anastomostic Leakage (n)
Sweet procedure group	n=43	0	n=41	0	-
Ivor-Lewis procedure group	n=29	0	n=34	0	-
Postoperative Hospital Stay (d)
Sweet procedure group	n=43	10.3±1.8	n=41	10.5±2.3	0.691
Ivor-Lewis procedure group	n=29	11.0±2.7	n=34	11.4±2.1	0.295