title: Rescue pyloroplasty for refractory delayed gastric emptying following esophagectomy.
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.
  
  
  CONCLUSIONS
  rPP for post-esophagectomy DGE is well-tolerated, results in improvements in symptoms and pharmacologic dependence, and satisfactorily preserves QoL.
authors: Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Electronic address: jashodeep.datta@uphs.upenn.edu.
authors: Jashodeep
authors: J
authors: Datta
authors: Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors: Noel N
authors: NN
authors: Williams
authors: Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors: R Gregory
authors: RG
authors: Conway
authors: Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors: Daniel T
authors: DT
authors: Dempsey
authors: Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors: Jon B
authors: JB
authors: Morris
mesh_terms: D000368:Aged; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D018589:Gastroparesis / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome