Intraoperative Pyloric Interventions during Oesophagectomy: a Multicentre Study

• Published in: Journal of gastrointestinal surgery Vol. 22; no. 8; pp. 1319 - 1324
• Main Authors: Marchese, Salvatore, Qureshi, Yassar A., Hafiz, Shazia P., Dawas, Khaled, Turner, Paul, Mughal, M. Muntzer, Mohammadi, Borzoueh
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-08-2018; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Botulinum toxin; Botulinum Toxins - administration & dosage; Endoscopy; Endoscopy, Gastrointestinal; Esophageal Neoplasms - surgery; Esophagectomy - adverse effects; Female; Gastric Emptying; Gastroenterology; Gastrointestinal surgery; Gastroparesis - etiology; Gastroparesis - prevention & control; Humans; Intubation, Gastrointestinal; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Neurotoxins - administration & dosage; Original Article; Postoperative Period; Pylorus - drug effects; Pylorus - surgery; Retrospective Studies; Surgery; Time Factors; Young Adult; Pyloroplasty; Pyloric drainage; Delayed gastric emptying; Oesophagectomy; Botulinum toxin
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-018-3759-0

Background
Denervation of the pylorus after oesophagectomy is considered the principal factor responsible for delayed gastric emptying. Several studies have attempted to delineate whether surgical or chemical management of the pylorus during oesophagectomy is of benefit, but with conflicting results. The aim of this multicentre study was to assess whether there was any difference in outcomes between different approaches to management of the pylorus.
Methods
A prospectively maintained database was used to identify patients who underwent oesophagectomy for malignancy. They were divided into separate cohorts based on the specific pyloric intervention: intra-pyloric botulinum toxin injection, pyloroplasty and no pyloric treatment. Main outcome parameters were naso-gastric tube duration and re-siting, endoscopic pyloric intervention after surgery both as in- and outpatient, length of hospital stay, in-hospital mortality and delayed gastric emptying symptoms at first clinic appointment.
Results
Ninety patients were included in this study, 30 in each group. The duration of post-operative naso-gastric tube placement demonstrated significance between the groups (
p
 = 0.001), being longer for patients receiving botulinum treatment. The requirement for endoscopic pyloric treatment after surgery was again poorer for those receiving botulinum (
p
 = 0.032 and 0.003 for inpatient and outpatient endoscopy, respectively).
Conclusion
We did not find evidence of superiority of surgical treatment or botulinum toxin of the pylorus, as prophylactic treatment for potential delayed gastric emptying after oesophagectomy, compared to no treatment at all. Based on our findings, no treatment of the pylorus yielded the most favourable outcomes.