Delayed Gastric Emptying after Esophagectomy: Management and Prevention

Abstract

The quality of life associated with eating is becoming an increasingly significant problem for patients who undergo esophagectomy as a result of the improved survival rate after esophageal cancer surgery. Delayed gastric emptying (DGE) is a common complication after esophagectomy. Although several strategies have been proposed for the management and prevention of DGE, no clear consensus exists. The purpose of this review is to present a brief overview of DGE and to help clinicians choose the most appropriate treatment through an analysis of DGE by cause. Furthermore, we would like to suggest some tips to prevent DGE based on our experience.

Short-term outcome of Ivor Lewis esophagectomy following neoadjuvant chemoradiation versus perioperative chemotherapy in patients with locally advanced adenocarcinoma of the esophagus and gastroesophageal junction: a propensity score-matched analysis

“…Independent from the kind of neoadjuvant therapy it is due to the radical nature of the surgery that a vagotomy is often inevitable and, therefore, the parasympathetic effects of the vegetative nervous system can no longer affect the function of the pylorus. Still today this is a common circumstance directly influencing the patients’ postsurgical gastrointestinal function and quality of life (Maus et al 2016 ; Zhang and Zhang 2019 ; Yang et al 2020 ). However, to our best knowledge, there are almost no data available so far focusing on this important issue.…”

Pyloroplasty Reduces the Need for Pyloric Dilatation After Esophagectomy

“…3 The symptoms of DGCE can have distressing impacts on a patient’s quality of life and are strongly associated with adverse outcomes such as thoracic food retention, nutritional problems, anastomotic leak, pneumonia, and longer hospital stays. 4-6…”

“…3 The symptoms of DGCE can have distressing impacts on a patient's quality of life and are strongly associated with adverse outcomes such as thoracic food retention, nutritional problems, anastomotic leak, pneumonia, and longer hospital stays. [4][5][6] Some surgeons opt to perform pyloroplasty as an adjunct procedure at the same time as esophagectomy to minimize the effects of DGCE. Performing a pyloroplasty acts to widen the gastric outlet, allowing the gastric contents to pass through more easily and thus in theory remove any pyloric obstruction that may occur as a result of the esophagectomy.…”

Microbiota profiling in esophageal diseases: Novel insights into molecular staining and clinical outcomes

“…dominate the niche due to their ability to resist low pH and inhibit competitor bacteria through lactic acid production [125] . As well established, high lactate levels promote tumorigenesis and progression through angiogenesis, immune escape, cell migration, and metastasis [129] . Additionally, a high prevalence of Candida albicans and Candida glabrata in EAC samples was found, indicating the existence of esophageal fungal microbiota [128] .…”