Pyloroplasty or pyloromyotomy is often undertaken during esophagectomy to improve conduit function and potentially reduce complications. Minimally invasive esophagectomy (MIE) frequently omits a pyloric procedure. The impact on peri-operative outcomes and the need for subsequent interventions on the pylorus are unclear. This study assesses the requirements for endoscopic balloon dilation of the pylorus (EPD) following MIE. Patients undergoing MIE from 2016–2020 were reviewed. Patients undergoing hybrid or open resection, or an intraoperative pyloric procedure were excluded. Demographic, clinical, and pathological data were reviewed. Data on the need for post-operative EPD in the short- and long-term settings were recorded. Univariable and multivariable analysis were performed as appropriate. 171 patients underwent MIE. There were no differences in age (p = 0.6), stage (p = 0.10) or ASA status (p = 0.52) between those requiring and not requiring EPD. Forty-three patients (25%) required EPD. Twenty-seven patients (16%) had EPD on their index admission. Seventy-five patients (43%) had a post-operative complication. There was a correlation between complications and the requirement for EPD both on the index admission (p < 0.001) and subsequently (p < 0.001). On multivariable analysis, there was no association between EPD and overall survival (p = 0.14). Eight patients (5%) required insertion of a feeding jejunostomy. Two patients underwent surgical pyloromyotomy for delayed gastric emptying. Although pyloroplasty or pyloromyotomy can safely be excluded during MIE, a quarter of patients will require post-operative EPD procedures, for delayed gastric emptying or as part of management of post-operative complications. The impact of excluding pyloric procedures on gastric emptying requires further study.

Summary Pyloroplasty or pyloromyotomy is often undertaken during esophagectomy to aid gastric emptying postoperatively. Minimally invasive esophagectomy (MIE) frequently omits a pyloric procedure. The impact on perioperative outcomes and the need for subsequent interventions is unclear. This study assesses the requirements for endoscopic balloon dilation of the pylorus (EPD) following MIE. Patients undergoing MIE from 2016 to 2020 were reviewed. Patients undergoing open resection, or an intraoperative pyloric procedure were excluded. Demographic, clinical and pathological data were reviewed. Univariable and multivariable analysis were performed as appropriate. In total, 171 patients underwent MIE. There were no differences in age (median 65 vs. 65 years, P = 0.6), pathological stage (P = 0.10) or ASA status (P = 0.52) between those requiring and not requiring endoscopic pyloric dilation (EPD). Forty-three patients (25%) required EPD, with a total of 71 procedures. Twenty-seven patients (16%) had EPD on their index admission. Seventy-five patients (43%) had a postoperative complication. Higher ASA status was associated with increased requirement for EPD (odds ratio 10.8, P = 0.03). On multivariable analysis, there was no association between the need for a pyloric procedure and overall survival (P = 0.14). Eight patients (5%) required insertion of a feeding jejunostomy in the postoperative period, with no difference between those with or without EPD (P = 0.11). Two patients required subsequent surgical pyloromyotomy for delayed gastric emptying. Although pyloroplasty or pyloromyotomy can safely be excluded during MIE, a quarter of patients will require postoperative EPD procedures. The impact of excluding pyloric procedures on gastric emptying requires further study.