title: Gastric Outlet Obstruction After Esophagectomy: Retrospective Analysis of the Effectiveness and Safety of Postoperative Endoscopic Pyloric Dilatation.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
authors.forename: Martin K H
authors.initials: MK
authors.lastname: Maus
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
authors.forename: Jessica
authors.initials: J
authors.lastname: Leers
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Herbold
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Bludau
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
authors.forename: Seung-Hun
authors.initials: SH
authors.lastname: Chon
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Kleinert
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hescheler
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
authors.forename: Elfriede
authors.initials: E
authors.lastname: Bollschweiler
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
authors.forename: Arnulf H
authors.initials: AH
authors.lastname: Hölscher
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Schäfer
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany. hakan.alakus@uk-koeln.de.
authors.forename: Hakan
authors.initials: H
authors.lastname: Alakus
mesh_terms: D000328:Adult; D000368:Aged; D004106:Dilatation; D004724:Endoscopy / Q000009:adverse effects; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005746:Gastric Emptying; D017219:Gastric Outlet Obstruction / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011708:Pylorus / Q000601:surgery; D012189:Retrospective Studies