title: Thoracoscopic Implant of Neurostimulator for Delayed Gastric Conduit Emptying After Esophagectomy.
abstract: OBJECTIVE
  Gastroparesis is a clinical syndrome characterized by delayed gastric emptying in the absence of mechanical outlet obstruction. Use of the denervated stomach as an esophageal substitute is a common cause of transient gastroparesis. Gastric electrostimulation through a thoracotomy approach has previously been reported to be effective in patients with medically refractory postesophagectomy gastroparesis. We report the first thoracoscopic implant of a gastric neurostimulator.
  
  
  RESULTS
  A 57-year-old woman underwent Ivor Lewis esophagectomy for early stage (T1N0) adenocarcinoma in 2007. She progressively developed progressive dysphagia, regurgitation, and a 29-kg weight loss. The barium swallow study and upper gastrointestinal endoscopy showed a dilated intrathoracic stomach without evidence of mechanical obstruction. Erythromycin and multiple endoscopic dilatations of the pylorus were unsuccessful, and eventually, a feeding jejunostomy was performed. At the time the patient was referred to our outpatient clinic, she was unable to eat and depended on total enteral nutrition. Computed tomography, endoscopy, and barium swallow study confirmed that there was no evidence of recurrent adenocarcinoma or mechanical gastric outlet obstruction. A gastric electrostimulator system (Enterra(®)) was implanted through a right thoracoscopic access and connected to the gastric conduit. At 6-month follow-up, there was a significant improvement of the total symptom score and quality of life.
  
  
  CONCLUSIONS
  Electrostimulation of the gastric conduit after esophagectomy can safely be performed through a thoracoscopic approach and may represent a reasonable therapeutic option in patients with symptomatic and medically refractory delayed gastric emptying.
authors.affiliation: Department of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School , Milano, Italy .
authors.forename: Emanuele
authors.initials: E
authors.lastname: Asti
authors.affiliation: Department of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School , Milano, Italy .
authors.forename: Andrea
authors.initials: A
authors.lastname: Lovece
authors.affiliation: Department of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School , Milano, Italy .
authors.forename: Luigi
authors.initials: L
authors.lastname: Bonavina
mesh_terms: D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D018589:Gastroparesis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D058542:Implantable Neurostimulators; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D019919:Prosthesis Implantation / Q000379:methods; D011788:Quality of Life; D013906:Thoracoscopy; D016896:Treatment Outcome