Right gastroepiploic artery occlusion test for resection of recurrent lesion after esophageal reconstruction using a gastric tube

Background Blood supply to a reconstructed gastric tube after esophagectomy is mainly through the right gastroepiploic artery (RGEA); therefore, a recurrent lesion involving the RGEA is thought to be unresectable, or if possible, resectable combined with a whole gastric tube. Methods We developed a new method of right gastroepiploic artery occlusion test for evaluation of the blood circulation of a reconstructed gastric tube in a patient who has a recurrent lesion involving the RGEA. A balloon occlusion catheter is inserted into the RGEA through the celiac trunk through a 7 Fr angiographic catheter, and the balloon is inflated. Celiac angiography and color Doppler endoscopic ultrasonography can evaluate intragastric blood flow from the right gastric artery during occlusion of the RGEA. Results We present a case of successful resection of celiac lymph node metastasis invading the RGEA and the celiac trunk after esophageal reconstruction using a gastric tube. Conclusions When ligation of the right gastroepiploic artery is needed, the test is safe and simple to perform; and findings can be reliably evaluated by angiography and color Doppler endoscopic ultrasonography.