Skip to main content

Endoscopic pyloric balloon dilatation obviates the need for pyloroplasty at esophagectomy



Because the rate of acquired pyloric stenosis (APS) from truncal vagotomy is 15%, many surgeons perform pyloroplasty or pyloromyotomy at the time of esophagectomy. Endoscopic pyloric balloon dilatation (EPBD) is another method to manage APS. This study evaluated a cohort treated with preoperative EPBD.


This is a retrospective review of all patients treated with preoperative EPBD and esophagectomy for cancer from 2002 to 2009 at Brigham and Women’s Hospital, a tertiary care center. Outcome measures included need for subsequent surgery for gastric outlet obstruction, rate of pyloric stenosis noted on postoperative endoscopy, and complications.


Upon review of the series, 25 patients (80% male; median age, 63 [range 47–81] years) had outpatient preoperative EPBD and esophagectomies 1–2 weeks later and were included in the study. None had pyloroplasties or pyloromyotomies at the time of esophagectomy. Selected patients had postoperative endoscopy. Of the 25 patients, 20 had transhiatal esophagectomies, 3 had thoracoabdominal esophagectomies, and 2 had VATS 3-hole esophagectomies. Median follow-up time was 22 (range, 1–84) months. There were no complications from EPBD. There were no postoperative deaths. No patient needed a second operation for gastric outlet obstruction. All patients had postoperative barium swallows (BaS) or endoscopy or both. Only one patient (4%) required one postoperative EPBD to dilate a 16-mm pylorus. Three others had delayed gastric emptying on BaS with endoscopy showing each pylorus was wide open. Their symptoms improved with time.


In this cohort, preoperative EPBD in all patients combined with postoperative EPBD in one patient obviated the need for pyloroplasty. This approach merits further study in a larger cohort, particularly to determine whether preoperative EPBD is necessary or if only selected postoperative EPBD is sufficient.

This is a preview of subscription content, access via your institution.


  1. Dragstedt LR (1935) Some physiologic principles involved in the surgical treatment of gastric and duodenal ulcer. Ann Surg 102:563–580

    PubMed  Article  CAS  Google Scholar 

  2. Clarke JS, Storer EH, Dragstedt LR (1947) The effects of vagotomy on the physiology of the stomach in patients with peptic ulcer. J Clin Invest 26:784–795

    Article  CAS  Google Scholar 

  3. Holscher AH, Schneider PM, Gutschow C, Schroder W (2007) Laparoscopic ischemic conditioning of the stomach for esophageal replacement. Ann Surg 245:241–246

    PubMed  Article  Google Scholar 

  4. Urschel JD, Blewett CJ, Young JE, Miller JD, Bennett WF (2002) Pyloric drainage (pyloroplasty) or no drainage in gastric reconstruction after esophagectomy: a meta-analysis of randomized controlled trials. Dig Surg 19:160–164

    PubMed  Article  Google Scholar 

  5. Palmes D, Weilinghoff M, Colombo-Benkmann M, Senninger N, Bruewer M (2007) Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction. Langenbecks Arch Surg 392:135–141

    PubMed  Article  Google Scholar 

  6. Bonavina L (2008) Comments on the publication Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction by Palmes et al. Langenbecks Arch Surg 393:117–118; author reply 119–120

    Google Scholar 

  7. Lee HS, Kim MS, Lee JM, Kim SK, Kang KW, Zo JI (2005) Intrathoracic gastric emptying of solid food after esophagectomy for esophageal cancer. Ann Thorac Surg 80:443–447

    PubMed  Article  Google Scholar 

  8. Kim JH, Lee HS, Kim MS, Lee JM, Kim SK, Zo JI (2008) Balloon dilatation of the pylorus for delayed gastric emptying after esophagectomy. Eur J Cardiothorac Surg 33:1105–1111

    PubMed  Article  Google Scholar 

  9. Finley FJ, Lamy A, Clifton J, Evans KG, Fradet G, Nelems B (1995) Gastrointestinal function following esophagectomy for malignancy. Am J Surg 169:471–475

    PubMed  Article  CAS  Google Scholar 

  10. Bemelman WA, Taat CW, Slors JF, van Lanschot JJ, Obertop H (1995) Delayed postoperative emptying after esophageal resection is dependent on the size of the gastric substitute. J Am Coll Surg 180:461–464

    PubMed  CAS  Google Scholar 

  11. Barbera L, Kemen M, Wegener M, Jergas M, Zumtobel V (1994) Effect of site and width of stomach tube after esophageal resection on gastric emptying. Zentralbl Chir 119:240–244

    PubMed  CAS  Google Scholar 

  12. Lanuti M, de Delva PE, Wright CD, Gaissert HA, Wain JC, Donahue DM, Allan JS, Mathisen DJ (2007) Post-esophagectomy gastric outlet obstruction: role of pyloromyotomy and management with endoscopic pyloric dilatation. Eur J Cardiothorac Surg 31:149–153

    PubMed  Article  Google Scholar 

  13. Fok M, Cheng SW, Wong J (1991) Pyloroplasty versus no drainage in gastric replacement of the esophagus. Am J Surg 162:447–452

    PubMed  Article  CAS  Google Scholar 

  14. Gupta S, Chattopadhyay TK, Gopinath PG, Kapoor VK, Sharma LK (1989) Emptying of the intrathoracic stomach with and without pyloroplasty. Am J Gastroenterol 84:921–923

    PubMed  CAS  Google Scholar 

  15. Mannell A, McKnight A, Esser JD (1990) Role of pyloroplasty in the retrosternal stomach: results of a prospective, randomized, controlled trial. Br J Surg 77:57–59

    PubMed  Article  CAS  Google Scholar 

  16. Kao CH, Chen CY, Chen CL, Wang SJ, Yeh SH (1994) Gastric emptying of the intrathoracic stomach as oesophageal replacement for oesophageal carcinomas. Nucl Med Commun 15:152–155

    PubMed  Article  CAS  Google Scholar 

  17. Zieren HU, Muller JM, Jacobi CA, Pichlmaier H (1995) Should a pyloroplasty be carried out in stomach transposition after subtotal esophagectomy with esophago-gastric anastomosis at the neck? A prospective randomized study. Chirurg 66:319–325

    PubMed  CAS  Google Scholar 

  18. Kobayashi A, Ide H, Eguchi R, Nakamura T, Hayashi K, Hanyu F (1996) The efficacy of pyloroplasty affecting to oral-intake quality of life using reconstruction with gastric tube post esophagectomy. Nippon Kyobu Geka Gakkai Zasshi 44:770–778

    PubMed  CAS  Google Scholar 

  19. Tamim WZ, Davidson RS, Quinlan RM, O’Shea MA, Orr RK, Swanson RS (1998) Neoadjuvant chemoradiotherapy for esophageal cancer: is it worthwhile? Arch Surg 133:722–726

    PubMed  Article  CAS  Google Scholar 

  20. Manjari R, Padhy AK, Chattopadhyay TK (1996) Emptying of the intrathoracic stomach using three different pylorus drainage procedures: results of a comparative study. Surg Today 26:581–585

    PubMed  Article  CAS  Google Scholar 

  21. Tcherniak A, Kashtan DH, Melzer E (2006) Successful treatment of gastroparesis following total esophagectomy using botulinum toxin. Endoscopy 38(2):196

    PubMed  Article  CAS  Google Scholar 

  22. Reddymasu SC, Singh S, Sankula R, Lavenbarg TA, Olyaee M, McCallum RW (2009) Endoscopic pyloric injection of botulinum toxin-A for the treatment of postvagotomy gastroparesis. Am J Med Sci 337(3):161–164

    PubMed  Article  Google Scholar 

Download references


Edward W. Swanson, Scott J. Swanson, and Richard S. Swanson have no financial, commercial, or other interests related to this manuscript to disclose.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Richard S. Swanson.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Swanson, E.W., Swanson, S.J. & Swanson, R.S. Endoscopic pyloric balloon dilatation obviates the need for pyloroplasty at esophagectomy. Surg Endosc 26, 2023–2028 (2012).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Esophagectomy
  • Balloon dilatation
  • Gastric outlet obstruction
  • Pyloric drainage