Intraoperative Pyloric Interventions during Oesophagectomy: a Multicentre Study

Marchese, Salvatore; Qureshi, Yassar A.; Hafiz, Shazia; Dawas, Khaled; Turner, Paul; Mughal, Muntzer; Mohammadi, Borzoueh

doi:10.1007/s11605-018-3759-0

Cited by 10 publications

(8 citation statements)

References 19 publications

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“…Marchese and colleagues demonstrated that intraoperative Botox increased the length of time required for postoperative nasogastric tube and resulted in higher rates of requirement for endoscopic pyloric treatment when compared with surgical drainage procedures and no surgical drainage procedures. 14 further pyloric intervention. 13 Eldaif and colleagues demonstrated that intraoperative Botox results in increased postoperative reflux symptoms without decreasing the need for pro-motility agents when compared with surgical draining procedures, suggesting that intraoperative Botox may increase rates of complications without confirming the same benefit of surgical drainage procedures.…”

Section: Discussionmentioning

confidence: 97%

“…[10][11][12] Some reports, however, have failed to confirm any benefit of intraoperative Botox, 13 or even suggest that intraoperative Botox may increase complication rates when compared with no drainage procedure. 14 We believe that DGE should be managed expectantly. DGE can be managed with systemic pharmacotherapy in the majority of instances.…”

Section: Introductionmentioning

confidence: 93%

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Endoscopic Botulinum toxin as a treatment for delayed gastric emptying following oesophagogastrectomy

Nevins

Rao

Nicholson

et al. 2020

annals

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Introduction The incidence of delayed gastric emptying (DGE) following oesophagogastrectomy with gastric conduit reconstruction is reported to be between 1.7% and 50%. This variation is due to differing practices of intraoperative pylorus drainage procedures, which increase the risk of postoperative biliary reflux and dumping syndrome, resulting in significant morbidity. The aim of our study was to establish rates of DGE in people undergoing oesophagogastrectomy without routine intraoperative drainage procedures, and to evaluate outcomes of postoperative endoscopically administered Botulinum toxin into the pylorus (EBP) for people with DGE resistant to systemic pharmacological treatment. Methods All patients undergoing oesophagogastrectomy between 1 January 2016 and 31 March 2018 at our unit were included. No intraoperative pyloric drainage procedures were performed, and DGE resistant to systemic pharmacotherapy was managed with EBP. Results Ninety-seven patients were included. Postoperatively, 29 patients (30%) were diagnosed with DGE resistant to pharmacotherapy. Of these, 16 (16.5%) were diagnosed within 30 days of surgery. The median pre-procedure nasogastric tube aspirate was 780ml; following EBP, this fell to 125ml (p<0.001). Median delay from surgery to EBP in this cohort was 13 days (IQR 7–16 days). Six patients required a second course of EBP, with 100% successful resolution of DGE before discharge. There were no procedural complications. Conclusions This is the largest series of patients without routine intraoperative drainage procedures. Only 30% of patients developed DGE resistant to pharmacotherapy, which was managed safely with EBP in the postoperative period, thus minimising the risk of biliary reflux in people who would otherwise be at risk following prophylactic pylorus drainage procedures.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 93%

Endoscopic Botulinum toxin as a treatment for delayed gastric emptying following oesophagogastrectomy

Nevins

Rao

Nicholson

et al. 2020

annals

View full text Add to dashboard Cite

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“…However, the objective assessment such as endoscopy at 1-year follow-up and postoperative p-amylase levels in the gastric conduit clearly showed the efficacy of Roux-en-Y plus duodenal diversion 1 . In this study, we did not perform any pyloric drainage procedures such as pyloroplasty or pyloromyotomy in the non-Rouxen-Y group, because it remains controversial whether such procedures improve delayed gastric emptying after esophagectomy 2–5 …”

mentioning

confidence: 89%

Response to Comment on “Randomized Comparison of Gastric Tube Reconstruction With and Without Duodenal Diversion Plus Roux-en-Y Anastomosis After Esophagectomy” by Dr Prakash et al

et al. 2020

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They can never sleep at night in a flat supine position and continue to complain of regurgitation for the rest of their lives.If just a 1-hour longer surgery could completely ease such uncomfortable symptoms, it could be one of the treatment options. All patients who underwent non-RY anastomosis do not always suffer from DGE and gastroduodenal reflux (GDR).From the results of our study, 20% to 40% of the non-Roux-en-Y patients complain of severe DGE. They may be true candidates for Roux-en-Y reconstruction. How to identify such patients before surgery is a next question.

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“…The most common options for the management of the pylorus include pyloromyotomy, pyloroplasty, intrapyloric botulinum toxin injection as well as no intervention. While one multicenter study showed no significant difference between pyloroplasty, botulinum toxin-injection, and no pyloric treatment, one study did show that intra-pyloric botulinum toxin can increase the risk of postoperative reflux and increase the use of promotility agents and endoscopic interventions [84,85]. While delayed gastric emptying can occur anywhere from 10 to 50%, it also can be successfully managed with prokinetic agents (75%) and endoscopic dilation [86].…”

Section: Delayed Gastric Emptyingmentioning

confidence: 99%

Prevention and Management of Complications from Esophagectomy

Oxenberg¹

2018

Esophageal Cancer and Beyond

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While surgery plays a major role in the treatment and potential cure of esophageal cancer, esophagectomy continues to have a significant amount of morbidity compared to other surgical oncology procedures. Efforts to improve morbidity and mortality from esophagectomy include the Consensus Guidelines for Complications from Esophagectomies, Enhanced Recovery after Surgery protocols as well as others. Although we strive to improve morbidity and mortality after these surgeries, adverse events still occur. They affect not only patient quality of life and increase cost of care for esophageal cancer but also have a negative impact on overall cancer survival. This chapter reviews the prevention of adverse outcomes from esophagectomies as well as discusses the management of many complications that may occur more common to the operation.

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Intraoperative Pyloric Interventions during Oesophagectomy: a Multicentre Study

Cited by 10 publications

References 19 publications

Endoscopic Botulinum toxin as a treatment for delayed gastric emptying following oesophagogastrectomy

Endoscopic Botulinum toxin as a treatment for delayed gastric emptying following oesophagogastrectomy

Response to Comment on “Randomized Comparison of Gastric Tube Reconstruction With and Without Duodenal Diversion Plus Roux-en-Y Anastomosis After Esophagectomy” by Dr Prakash et al

Prevention and Management of Complications from Esophagectomy

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