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For: Abdelrahman M, Ariyarathenam A, Berrisford R, Humphreys L, Sanders G, Wheatley T, Chan DSY. Systematic review and meta-analysis of the influence of prophylactic pyloric balloon dilatation in the prevention of early delayed gastric emptying after oesophagectomy. Dis Esophagus 2022;35:6363055. [PMID: 34476470 DOI: 10.1093/dote/doab062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 01/10/2023]

For:	Abdelrahman M, Ariyarathenam A, Berrisford R, Humphreys L, Sanders G, Wheatley T, Chan DSY. Systematic review and meta-analysis of the influence of prophylactic pyloric balloon dilatation in the prevention of early delayed gastric emptying after oesophagectomy. Dis Esophagus 2022;35:6363055. [PMID: 34476470 DOI: 10.1093/dote/doab062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 01/10/2023]

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Cited by Other Article(s)

Dell’Anna G, Mandarino FV, Fanizza J, Fasulo E, Barchi A, Barà R, Vespa E, Viale E, Azzolini F, Fanti L, Battaglia S, Puccetti F, Cossu A, Elmore U, Fuccio L, Annese V, Malesci A, Rosati R, Danese S. Endoscopic Management of Post-Esophagectomy Delayed Gastric Conduit Emptying (DGCE): Results from a Cohort Study in a Tertiary Referral Center with Comparison between Procedures. Cancers (Basel) 2024;16:3457. [PMID: 39456551 PMCID: PMC11505969 DOI: 10.3390/cancers16203457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Revised: 10/07/2024] [Accepted: 10/11/2024] [Indexed: 10/28/2024] Open

Abstract

Background/Objectives: Delayed gastric conduit emptying (DGCE) occurs in 15-39% of patients who undergo esophagectomy. Intra-Pyloric Injection of Botulinum Toxin (IPBT), Pneumatic Balloon Dilation (PBD), and the same session combination (BTPD) represent the main endoscopic procedures, but comparative data are currently unavailable. Methods: We retrospectively analyzed prospectively collected data on all consecutive patients with DGCE treated endoscopically with IPBT, PBD, or BTPD. ISDE Diagnostic Criteria were used for DGCE diagnosis and classification. A Gastric Outlet Obstruction Score was used for clinical staging. All patients undergoing IPBT received 100 UI of toxin, while those undergoing PBD were dilated up to 20 mm. Clinical success (CS) was defined as the resolution of symptoms/resumption of feeding at discharge or expanding dietary intake at any rate. Recurrence was defined as symptom relapse after more than 15 days of well-being requiring endoscopic/surgical intervention. Results: A total of 64 patients (81.2% male, 90.6% Ivor-Lewis esophagectomy, 77.4% adenocarcinoma) with a median age of 62 years (IQR 55-70) were enrolled: 18 (28.1%) in the IPBT group, 24 (37.5%) in the PBD group, and 22 (34.4%) in the BTPD group. No statistically significant differences were found in the baseline characteristics, surgical techniques, and median follow-up among the three groups. BTPD showed a higher CS rate (100%) compared to the PD and BTPD groups (p = 0.02), and a Kaplan-Meier analysis with a log-rank test revealed that the BTPD group was associated both with a significatively shorter mean time to refeed of 1.16 days (95% CI 0.8-1.5; p = 0.001) and a shorter median time to discharge of one day (95% CI 1-3; p = 0.0001). Conclusions: Endoscopic management of DGCE remains challenging. Waiting for further strong evidence, BTPD can offer patients a higher clinical efficacy rate and a shorter time to refeed and be discharged.

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Affiliation(s)

Giuseppe Dell’Anna Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.) Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Italy;
Francesco Vito Mandarino Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.) Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
Jacopo Fanizza Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.) Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
Ernesto Fasulo Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.) Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
Alberto Barchi Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.) Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
Rukaia Barà Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.) Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
Edoardo Vespa Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.)
Edi Viale Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.)
Francesco Azzolini Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.)
Lorella Fanti Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.)
Silvia Battaglia Gastrointestinal Surgery Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (S.B.); (F.P.); (A.C.)
Francesco Puccetti Gastrointestinal Surgery Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (S.B.); (F.P.); (A.C.)
Andrea Cossu Gastrointestinal Surgery Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (S.B.); (F.P.); (A.C.)
Ugo Elmore Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.) Gastrointestinal Surgery Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (S.B.); (F.P.); (A.C.)
Lorenzo Fuccio Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy;
Vito Annese Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Italy; Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
Alberto Malesci Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.) Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
Riccardo Rosati Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.) Gastrointestinal Surgery Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (S.B.); (F.P.); (A.C.)
Silvio Danese Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.) Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)

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Bolger JC, Lau H, Yeung JC, Darling GE. Omission of intraoperative pyloric procedures in minimally invasive esophagectomy: assessing the impact on patients. Dis Esophagus 2023;36:6694033. [PMID: 36073933 DOI: 10.1093/dote/doac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 12/11/2022]