Jashodeep Datta1, Noel N Williams2, R Gregory Conway2, Daniel T Dempsey2, Jon B Morris2. 1. Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Electronic address: jashodeep.datta@uphs.upenn.edu. 2. Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Abstract
BACKGROUND: Delayed gastric emptying (DGE) following esophagectomy is a debilitating complication. Rarely, failure of postoperative endoscopic therapy may necessitate rescue pyloroplasty (rPP). METHODS: We conducted a retrospective, single-institution review of rPP for post-esophagectomy DGE from 2000 to 2013. Pre- and postoperative symptoms and pharmacologic use were examined. "Successful" rPP was defined as resolution of symptoms and pharmacologic requirements postoperatively. Quality of life (QoL) was evaluated by Short Form-12 and study-specific questionnaires. RESULTS: Thirteen patients underwent open transabdominal rescue Heineke-Mikulicz pyloroplasty. Between esophagectomy and rPP, average interval weight loss was 19 ± 15 lb over 13 months (range, 3-22). Patients underwent 3.4 ± 1.0 preoperative endoscopic balloon dilation (EBD) attempts, with 7 (54%) receiving endoscopic intrapyloric botulinum toxin (IPB) injections. Median follow-up was 12 months (range, 4-23). After rPP, the incidence of nausea, vomiting, bloating, prokinetic use, and total parenteral nutrition/total enteral nutrition dependence decreased (all P < .01). All patients gained weight; 2 developed biliary reflux. Nine of 13 patients were identified as rPP successes; predictors of rPP failure were American Society of Anesthesiologists grade 3 (P = .02), greater number of EBD attempts (P = .02), longer time to rPP (P = .03), and fewer IPB injections (P = .03). QoL assessment revealed general satisfaction with postoperative outcomes and excellent physical and mental functioning. CONCLUSION: rPP for post-esophagectomy DGE is well-tolerated, results in improvements in symptoms and pharmacologic dependence, and satisfactorily preserves QoL.
BACKGROUND: Delayed gastric emptying (DGE) following esophagectomy is a debilitating complication. Rarely, failure of postoperative endoscopic therapy may necessitate rescue pyloroplasty (rPP). METHODS: We conducted a retrospective, single-institution review of rPP for post-esophagectomy DGE from 2000 to 2013. Pre- and postoperative symptoms and pharmacologic use were examined. "Successful" rPP was defined as resolution of symptoms and pharmacologic requirements postoperatively. Quality of life (QoL) was evaluated by Short Form-12 and study-specific questionnaires. RESULTS: Thirteen patients underwent open transabdominal rescue Heineke-Mikulicz pyloroplasty. Between esophagectomy and rPP, average interval weight loss was 19 ± 15 lb over 13 months (range, 3-22). Patients underwent 3.4 ± 1.0 preoperative endoscopic balloon dilation (EBD) attempts, with 7 (54%) receiving endoscopic intrapyloric botulinum toxin (IPB) injections. Median follow-up was 12 months (range, 4-23). After rPP, the incidence of nausea, vomiting, bloating, prokinetic use, and total parenteral nutrition/total enteral nutrition dependence decreased (all P < .01). All patients gained weight; 2 developed biliary reflux. Nine of 13 patients were identified as rPP successes; predictors of rPP failure were American Society of Anesthesiologists grade 3 (P = .02), greater number of EBD attempts (P = .02), longer time to rPP (P = .03), and fewer IPB injections (P = .03). QoL assessment revealed general satisfaction with postoperative outcomes and excellent physical and mental functioning. CONCLUSION: rPP for post-esophagectomy DGE is well-tolerated, results in improvements in symptoms and pharmacologic dependence, and satisfactorily preserves QoL.
Authors: Andrew T Strong; Joshua P Landreneau; Michael Cline; Matthew D Kroh; John H Rodriguez; Jeffrey L Ponsky; Kevin El-Hayek Journal: J Gastrointest Surg Date: 2019-02-26 Impact factor: 3.452
Authors: Alexander Mertens; Jan Gooszen; Paul Fockens; Rogier Voermans; Suzanne Gisbertz; Arjan Bredenoord; Mark Ivo van Berge Henegouwen Journal: Dig Surg Date: 2021-11-02 Impact factor: 2.588