HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Michael Lanuti Cameron D. Wright Henning A. Gaissert John C. Wain Dean M. Donahue James S. Allan Douglas J. Mathisen Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lanuti, M. Articles by Mathisen, D. J. Search for Related Content PubMed PubMed Citation Articles by Lanuti, M. Articles by Mathisen, D. J. Related Collections Esophagus - cancer Esophagus - other

Eur J Cardiothorac Surg 2007;31:149-153. doi:10.1016/j.ejcts.2006.11.010
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Post-esophagectomy gastric outlet obstruction: role of pyloromyotomy and management with endoscopic pyloric dilatation

Massachusetts General Hospital, 55 Fruit Street, Blake 1570, Boston, MA 02114, United States

Received 8 September 2006; accepted 6 November 2006.

^_* Corresponding author. Address: 55 Fruit Street, Blake 1570, Boston, MA 02114, United States. Tel.: +1 617 726 6751; fax: +1 617 726 7667. (Email: Mlanuti{at}partners.org).

Objective: Gastric outlet obstruction is common after esophagectomy. Our goal was to determine the incidence of gastric outlet obstruction after esophagectomy with or without pyloromyotomy and analyze its management by endoscopic pyloric dilatation. Methods: Two hundred forty-two patients underwent esophagectomy with gastric conduit from January 2002 to June 2006. Subjects were divided into two groups: Group A had no pyloromyotomy (n = 83) and Group B had a pyloromyotomy (n = 159). Gastric outlet obstruction was strictly defined to include patients with clinical delayed gastric emptying supported by symptoms, barium swallow studies, persistent air–fluid level and dilated conduit on radiography, or endoscopic or surgical intervention to improve gastric drainage. Results: The groups were similar except for a higher percentage of cervical anastomosis and older age (64- vs 61-year-old) in Group A. The overall incidence of gastric outlet obstruction was 15.3% (37/242). Pyloromyotomy did not reduce the incidence of gastric outlet obstruction (Group A 9.6% vs Group B 18.2%, p = 0.078). One patient required a late pyloroplasty. Successful management of gastric outlet obstruction with pyloric dilatation (96.7%, 28/29) was unaffected by pyloromyotomy. There was no difference in length of stay, pneumonia (Group A 27.7% vs Group B 19.5%, p = 0.15), respiratory failure or anastomotic stricture. There was no difference in anastomotic leaks when controlling for the anatomic location of the anastomosis (p = 0.36). Mortality was equivalent between groups (2.4 vs 2.5%, p = 0.96). Conclusion: Pyloromyotomy does not reduce the incidence of symptomatic delayed gastric emptying after esophagectomy. Post-operative gastric outlet obstruction can be effectively managed with endoscopic pyloric dilatation. Routine pyloromyotomy for the prevention of post-esophagectomy gastric outlet obstruction may be unwarranted.

Key Words: Esophagectomy • Esophageal cancer • Gastric outlet obstruction

This article has been cited by other articles:

				J. T. Martin, J. A. Federico, A. A. McKelvey, M. S. Kent, and T. Fabian Prevention of Delayed Gastric Emptying After Esophagectomy: A Single Center's Experience With Botulinum Toxin. Ann. Thorac. Surg., June 1, 2009; 87(6): 1708 - 1714. [Abstract] [Full Text] [PDF]

				S. Y. Song, K. J. Na, S. G. Oh, and B. H. Ahn Learning curves of minimally invasive esophageal cancer surgery. Eur. J. Cardiothorac. Surg., April 1, 2009; 35(4): 689 - 693. [Abstract] [Full Text] [PDF]

				J.-H. Kim, H.-S. Lee, M. S. Kim, J. M. Lee, S. K. Kim, and J. I. Zo Balloon dilatation of the pylorus for delayed gastric emptying after esophagectomy Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 1105 - 1111. [Abstract] [Full Text] [PDF]

				R. D. Page and M. J. Shackcloth Gastric outlet obstruction and respiratory complications after esophagectomy Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 552 - 552. [Full Text] [PDF]