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. 2021;38(5-6):337-342.
doi: 10.1159/000519785. Epub 2021 Nov 2.

Treating Early Delayed Gastric Tube Emptying after Esophagectomy with Pneumatic Pyloric Dilation

Alexander Mertens  1   2 , Jan Gooszen  1 , Paul Fockens  3 , Rogier Voermans  3 , Suzanne Gisbertz  1 , Arjan Bredenoord  3 , Mark Ivo van Berge Henegouwen  1
Affiliations

Treating Early Delayed Gastric Tube Emptying after Esophagectomy with Pneumatic Pyloric Dilation

Alexander Mertens et al. Dig Surg. 2021.

Abstract

Introduction: Endoscopic pneumatic pyloric balloon dilation is a treatment option for early postoperative delayed gastric tube emptying following esophageal resection. This study aimed to determine the safety and effectiveness of endoscopic balloon dilation.

Methods: Between 2015 and 2018, patients with delayed gastric emptying 8-10 days after esophageal resection with gastric tube reconstruction due to esophageal carcinoma were considered for inclusion. Inclusion criteria were ≥1 of the following: nasogastric tube production ≥500 mL/24 h, ≥300 mL gastric retention, ≥50% gastric tube dilatation on X-ray, or nasogastric tube replacement. Patients were excluded on evidence of anastomotic leakage or reintervention. Success was defined as the ability to expand intake without needing to replace the nasogastric tube. Dilation was performed using a 30-mm Rigiflex balloon.

Results: Fifteen patients underwent pyloric dilation, 12 according to the study protocol. Treatment was performed at a median of 12 days (IQR 9-15) postoperatively. Success was achieved in 58%. At 3 months, 8 patients progressed to exclusively oral intake. The remaining 4 patients had supplementary nightly enteral tube feeding. There were no adverse events.

Conclusion: Endoscopic balloon dilation of the pylorus is a safe, feasible therapy for early postoperative delayed gastric emptying. With a success rate of 58%, a clinical trial is a necessary next step.

Keywords: Delayed conduit emptying; Esophageal cancer surgery; Gastric tube reconstruction; Gastroparesis; Pyloric dilation.

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Conflict of interest statement

V.B.H. declares a research grant from Olympus and Stryker, in addition to consulting fees from Johnson and Johnson and Medtronic. P.F. declares consulting fees from Olympus, Cook, and Ethicon. The other authors have no conflicts of interest to declare.

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