Rescue pyloroplasty for refractory delayed gastric emptying following esophagectomy

Jashodeep Datta, Noel N. Williams, R. Gregory Conway, Daniel T. Dempsey, Jon B. Morris

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)290-297
Number of pages8
JournalSurgery (United States)
Volume156
Issue number2
DOIs
StatePublished - Aug 2014
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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