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Intraoperative Pyloric Interventions during Oesophagectomy: a Multicentre Study

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Denervation of the pylorus after oesophagectomy is considered the principal factor responsible for delayed gastric emptying. Several studies have attempted to delineate whether surgical or chemical management of the pylorus during oesophagectomy is of benefit, but with conflicting results. The aim of this multicentre study was to assess whether there was any difference in outcomes between different approaches to management of the pylorus.

Methods

A prospectively maintained database was used to identify patients who underwent oesophagectomy for malignancy. They were divided into separate cohorts based on the specific pyloric intervention: intra-pyloric botulinum toxin injection, pyloroplasty and no pyloric treatment. Main outcome parameters were naso-gastric tube duration and re-siting, endoscopic pyloric intervention after surgery both as in- and outpatient, length of hospital stay, in-hospital mortality and delayed gastric emptying symptoms at first clinic appointment.

Results

Ninety patients were included in this study, 30 in each group. The duration of post-operative naso-gastric tube placement demonstrated significance between the groups (p = 0.001), being longer for patients receiving botulinum treatment. The requirement for endoscopic pyloric treatment after surgery was again poorer for those receiving botulinum (p = 0.032 and 0.003 for inpatient and outpatient endoscopy, respectively).

Conclusion

We did not find evidence of superiority of surgical treatment or botulinum toxin of the pylorus, as prophylactic treatment for potential delayed gastric emptying after oesophagectomy, compared to no treatment at all. Based on our findings, no treatment of the pylorus yielded the most favourable outcomes.

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Authors and Affiliations

  1. Department of Oesophago-Gastric Surgery, University College Hospital, University College London Hospitals, 250 Euston Road, London, NW1 2PG, UK

    Salvatore Marchese, Yassar A. Qureshi, Khaled Dawas, M. Muntzer Mughal & Borzoueh Mohammadi

  2. Upper Gastrointestinal Service, Royal Preston Hospital, Lancashire Teaching Hospitals, Preston, UK

    Shazia P. Hafiz & Paul Turner

Authors
  1. Salvatore Marchese
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  2. Yassar A. Qureshi
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  3. Shazia P. Hafiz
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  4. Khaled Dawas
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  5. Paul Turner
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  6. M. Muntzer Mughal
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  7. Borzoueh Mohammadi
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Each author has participated significantly in the work and takes public responsibility for it.

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Correspondence to Borzoueh Mohammadi.

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Marchese, S., Qureshi, Y.A., Hafiz, S.P. et al. Intraoperative Pyloric Interventions during Oesophagectomy: a Multicentre Study. J Gastrointest Surg 22, 1319–1324 (2018). https://doi.org/10.1007/s11605-018-3759-0

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  • DOI: https://doi.org/10.1007/s11605-018-3759-0

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