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Gastric Outlet Obstruction After Esophagectomy: Retrospective Analysis of the Effectiveness and Safety of Postoperative Endoscopic Pyloric Dilatation

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Abstract

Background and aims

Delayed gastric emptying after esophagectomy with gastric replacement can pose a significant postoperative problem, often leading to aspiration and pneumonia. The present study analyzes retrospectively the effectiveness of endoscopic pyloric dilatation for post-surgical gastric outlet obstruction.

Methods

Between March 2006 and March 2010, 403 patients underwent a transthoracic en-bloc esophagectomy and reconstruction with a gastric tube and intrathoracic esophagogastrostomy. In patients with postoperative symptoms of an outlet dysfunction and the confirmation by endoscopy, pyloric dilatations were performed without preference with either 20- or 30-mm balloons.

Results

A total of 89 balloon dilatations of the pylorus after esophagectomy were performed in 60 (15.6 %) patients. In 21 (35 %) patients, a second dilatation of the pylorus was performed. 55 (61.8 %) dilatations were performed with a 30-mm balloon and 34 (38.2 %) with a 20-mm balloon. The total redilatation rate for the 30-mm balloon was 20 % (n = 11) and 52.9 % (n = 18) for the 20-mm balloon (p < 0.001). All dilatations were performed without any complications.

Conclusions

Pylorus spasm contributes to delayed gastric emptying leading to postoperative complications after esophagectomy. Endoscopic pyloric dilatation after esophagectomy is a safe procedure for treatment of gastric outlet obstruction. The use of a 30-mm balloon has the same safety profile but a 2.5 lower redilatation rate compared to the 20-mm balloon. Thus, the use of 20-mm balloons has been abandoned in our clinic.

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    Authors and Affiliations

    1. Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany

      Martin K. H. Maus, Jessica Leers, Till Herbold, Marc Bludau, Seung-Hun Chon, Robert Kleinert, Daniel A. Hescheler, Elfriede Bollschweiler, Arnulf H. Hölscher, Hartmut Schäfer & Hakan Alakus

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    1. Martin K. H. Maus
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    2. Jessica Leers
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    3. Till Herbold
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    7. Daniel A. Hescheler
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    8. Elfriede Bollschweiler
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    9. Arnulf H. Hölscher
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    11. Hakan Alakus
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    Correspondence to Hakan Alakus.

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    Conflict of interest

    Drs Martin Maus, Jessica Leers, Till Herbold, Marc Bludau, Seung-Hun Chon, Robert Kleinert, Daniel Hescheler, Elfriede Bollschweiler, Arnulf Hölscher, Hartmut Schäfer, and Hakan Alakus have no conflict of interest or financial ties to disclose.

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    Hartmut Schäfer and Hakan Alakus contributed equally to this article.

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    Maus, M.K.H., Leers, J., Herbold, T. et al. Gastric Outlet Obstruction After Esophagectomy: Retrospective Analysis of the Effectiveness and Safety of Postoperative Endoscopic Pyloric Dilatation. World J Surg 40, 2405–2411 (2016). https://doi.org/10.1007/s00268-016-3575-1

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    • DOI: https://doi.org/10.1007/s00268-016-3575-1

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