Prevention of Early Delayed Gastric Emptying After High-level Esophagogastrostomy by "pyloric Digital Fracture"

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2010 Aug 25

PMID 20734044

Citations 9

Authors

Bo Deng

Qun-You Tan

Yao-Guang Jiang

Yun-Ping Zhao

Jing-Hai Zhou

Guang-Chun Chen

Ru-Wen Wang

Affiliations

Soon will be listed here.

Abstract

Objective: This study was designed to evaluate the clinical efficacy of pyloric digital fracture for the prevention of early delayed gastric emptying (DGE) after high-level esophagogastrostomy.

Methods: From January 2004 to March 2009, we sequentially enrolled 78 patients after esophagogastrostomy: 48 patients with pyloric digital fracture (DF group) and 30 patients without any drainage procedure (non-DF group). Intraoperative manometric study was performed in 48 patients of the DF group. Postoperative evaluation was performed, including symptomatic questionnaire, radiographic study, and gastric scintigraphy.

Results: Intraoperative manometric study revealed that basal pyloric pressure and peak pressure of pylorus in phase III of the migrating motor complex increased significantly after gastric conduit was made and anastomosed, but decreased appreciably following digital fracture. Compared with the peak pressure of IPPW before digital fracture (88.52 ± 19.88 mmHg), it appreciably decreased following digital fracture (40.45 ± 13.52 mmHg). Occurrences of IPPW (in 10 min) and duration time of each occurrence (s) had similar trends for before and after digital fracture (11.5 ± 4.5 vs. 5.0 ± 3.5 and 7.0 ± 2.0 vs. 3.0 ± 1.0, respectively). Postoperative evaluation demonstrated that early DGE occurred in four patients in the non-DF group (13.3%), and there was no DGE patient in the DF group. There was significant difference regarding gastric scores between the DF group and the non-DF group (10.5 ± 3.4 vs. 16.7 ± 3.8, t = 2.8271, P < 0.05). Gastric scintigraphy revealed that either semi-emptying-time or percent of retention at 4 h of the DF group was significantly lower than that of the non-DF group.

Conclusion: Pyloric digital fracture can prevent early DGE after high-level esophagogastrostomy efficaciously and conveniently.

Citing Articles

Impact of nasogastric tube exclusion after minimally invasive esophagectomy for esophageal cancer: a single-center retrospective study in India.

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PMID: 38494183 PMC: 10961234. DOI: 10.7602/jmis.2024.27.1.23.

Outcomes of Intraoperative Pyloric Drainage on Delayed Gastric Emptying Following Esophagectomy: A Systematic Review and Meta-analysis.

Loo J, Ng A, Chan K, Oo A J Gastrointest Surg. 2023; 27(4):823-835.

PMID: 36650418 DOI: 10.1007/s11605-022-05573-w.

Treating Early Delayed Gastric Tube Emptying after Esophagectomy with Pneumatic Pyloric Dilation.

Mertens A, Gooszen J, Fockens P, Voermans R, Gisbertz S, Bredenoord A Dig Surg. 2021; 38(5-6):337-342.

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The Optimal Pyloric Procedure: A Collective Review.

Kim D Korean J Thorac Cardiovasc Surg. 2020; 53(4):233-241.

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Delayed emptying of the gastric conduit after esophagectomy.

Konradsson M, Nilsson M J Thorac Dis. 2019; 11(Suppl 5):S835-S844.

PMID: 31080667 PMC: 6503290. DOI: 10.21037/jtd.2018.11.80.

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