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Treatment Modalities for Delayed Gastric Emptying Following Esophagectomy
Francis J. Deasis*1, Matthew E. Gitelis1, John G. Linn1, 2, Joann Carbray1, Michael B. Ujiki1, 2
1Surgery, NorthShore University HealthSystem, Evanston, IL; 2Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL
Introduction:
Delayed gastric emptying (DGE) after esophagectomy is a common and debilitating complication. Management options include observation, endoscopic balloon dilation with Botox injection (EBD), and rescue pyloroplasty (rPP).
Methods:
A multi-surgeon, multi-hospital retrospective review of post-esophagectomy patients from 2008 to 2014 was conducted. Patients were screened based upon a confirmed DGE diagnosis. Methods of treatment were observation over time, EBD, or laparoscopic rPP. Demographics, pre- and postoperative symptoms, and perioperative data were assessed. Treatment success was defined as a resolution of symptoms after intervention.
Results:
DGE was radiologically confirmed in 26.5% of esophagectomy patients (9 out of 34). Median time between esophagectomy and diagnosis was 37 days (range 5-464). Gender was 88% male. Mean age was 54±16.5 years. Mean BMI was 30.8±10.1 kg/m2. Four patients (44%) had prior smoking history. Three (33%) patients were diabetic. Two patients were managed with observation. Three patients were treated with balloon dilatation and Botox. Four patients underwent laparoscopic rPP. Of the rPP patients, 3 (75%) underwent previous dilation with Botox. Median rPP ASA class was 3 (range 2-4). Median albumin was 3.8 g/dL (range 3.3-4). Median time between EBD and rPP was Operative time for rPP was median 79 minutes (range 72-238). One rPP was performed in conjunction with hiatal hernia repair. Median length of stay was 1.5 days (range 1-22). Mean pain at discharge (1-10) was 6±3.7. One rPP patient was readmitted 19 days postop for epigastric pain. Median followup was 276 days (range 30-1297). All rPP patients experienced symptom resolution, and they experienced no major complications.
Conclusions:
There are multiple, effective options for treating DGE. Patients who fail observation or EBD should undergo rPP. Early laparoscopic rPP should be considered due to its safety and efficacy.
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