title: Delayed gastric emptying after esophagectomy for malignancy.
abstract: BACKGROUND
  Controversy still exists about the need for pyloric drainage procedures after esophagectomy with gastric conduit reconstruction. Although pyloric drainage may prevent postoperative delayed gastric emptying (DGE), it may also promote dumping syndrome and bile reflux. The aims of this study were to audit the incidence and management of DGE in patients without routine pyloric drainage after esophagectomy in a university medical center.
  
  
  METHODS
  From July 2006 to June 2012, data from 356 consecutive patients who underwent esophagectomy with a gastric conduit without pyloric drainage for esophageal or gastric cardia carcinoma were reviewed. Major observation parameters were the incidence, management, and outcomes of DGE.
  
  
  RESULTS
  Overall incidence of DGE was 15.7% (56 of 356). Early DGE developed in 26 patients, and late DGE developed in 30 patients. There were no differences in demographic and intraoperative data between the two groups with or without DGE. More DGE was documented in patients with an intra-right thoracic gastric conduit (P=.031). A higher incidence of postoperative pneumonia was observed in patients exhibiting early DGE, but without significance (P=.254). There were also no significant impacts on respiratory failure (P=.848) and anastomotic leakage (P=.257). There was an increased postoperative hospital stay with DGE, but without significance (P=.089). Endoscopic balloon dilatation of the pylorus was used to manage 33.9% of patients with DGE, yielding a 78.9% (15 of 19) success rate without complications. In 3 patients endoscopy showed the pylorus was open, and their symptoms improved over time. One patient with tumor-related DGE was treated by pyloric stent. The remaining patients were adequately treated with conservative management.
  
  
  CONCLUSIONS
  Omitting the operative drainage procedure does not lead to an increased frequency of DGE after esophagectomy with a gastric conduit. Many patients responded to conservative management, and endoscopic balloon pyloric dilatation can be effective in managing the DGE postoperatively.
authors.affiliation: Department of Thoracic Surgery, Lanzhou University Second Hospital , Lanzhou University Second Clinical Medical College, Lanzhou, People's Republic of China .
authors.forename: Bin
authors.initials: B
authors.lastname: Li
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Zhang
authors.forename: Cheng
authors.initials: C
authors.lastname: Wang
authors.forename: Tie-Niu
authors.initials: TN
authors.lastname: Song
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Wang
authors.forename: Yun-Jiu
authors.initials: YJ
authors.lastname: Gou
authors.forename: Jian-Bao
authors.initials: JB
authors.lastname: Yang
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Wei
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002299:Cardia / Q000601:surgery*; D002404:Catheterization / Q000379:methods; D015897:Comorbidity; D004106:Dilatation / Q000379:methods; D004322:Drainage / Q000379:methods; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D018589:Gastroparesis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011708:Pylorus / Q000601:surgery; D013274:Stomach Neoplasms / Q000601:surgery*