Sage Journals: Discover world-class research

Abstract

Objective

Delayed gastric emptying (DGE) is a common functional disorder after esophagectomy in patients with esophageal carcinoma. Management of DGE varies widely and it is unclear how comorbidities influence the postoperative course. This study sought to determine factors that influence postoperative DGE.

Methods

This retrospective study evaluates patients who underwent esophagectomy with gastric pull-up between 2007 and 2019. The cohort was stratified in various ways to determine if postoperative care and outcomes differed, including patient demographics, comorbidities, intraoperative and postoperative procedures.

Results

During the study period, 149 patients underwent esophagectomy and 37 had diabetes. Overall incidence of DGE, as defined in this study, was 76.5%. Surgery type was significantly different between DGE and normal emptying cohorts (P = 0.005). Comparing diabetic and nondiabetic patients, there was no significant difference noted in DGE (P = 0.25). Additionally, there was no difference in presence of DGE for patients who underwent any intraoperative pyloric procedure compared to those who did not (P = 0.36). Of significance, all 16 patients with chronic obstructive pulmonary disease had a delay in gastric emptying (P = 0.01).

Conclusions

A higher proportion of patients with DGE post-esophagectomy were identified compared to the literature. There is little consensus on a true definition of DGE, but we believe this definition identifies patients suffering in the immediate postoperative period and in follow-up. There is no evidence to support a different postoperative course for patients with diabetes, but the link between chronic obstructive pulmonary disease and DGE warrants further investigation.

Keywords

esophagectomy delayed gastric emptying diabetes chronic obstructive pulmonary disorder

Get full access to this article

View all access options for this article.

References

Benedix

Willems

Kropf

et al. Risk factors for delayed gastric emptying after esophagectomy. Langenbecks Arch Surg 2017; 402: 547–554.doi:10.1007/s00423-017-1576-7

http://www.ncbi.nlm.nih.gov/pubmed/28324171

Zhang

Hou

S-C.

Miao

J-B

et al. Risk factors for delayed gastric emptying in patients undergoing esophagectomy without pyloric drainage. J Surg Res 2017; 213: 46–50.doi:10.1016/j.jss.2017.02.012

http://www.ncbi.nlm.nih.gov/pubmed/28601331

Fritz

Feilhauer

Schaudt

et al. Pylorus drainage procedures in thoracoabdominal esophagectomy - a single-center experience and review of the literature. BMC Surg 2018; 18: 13.doi:10.1186/s12893-018-0347-x

http://www.ncbi.nlm.nih.gov/pubmed/29490701

Akkerman

RDL.

Haverkamp

van Hillegersberg

et al. Surgical techniques to prevent delayed gastric emptying after esophagectomy with gastric interposition: a systematic review. Ann Thorac Surg 2014; 98: 1512–1519.doi:10.1016/j.athoracsur.2014.06.057

http://www.ncbi.nlm.nih.gov/pubmed/25152385

Nakabayashi

Mochiki

Garcia

et al. Gastropyloric motor activity and the effects of erythromycin given orally after esophagectomy. Am J Surg 2002; 183: 317–323.doi:10.1016/S0002-9610(02)00796-1

http://www.ncbi.nlm.nih.gov/pubmed/11943134

Dickman

Wainstein

Glezerman

et al. Gender aspects suggestive of gastroparesis in patients with diabetes mellitus: a cross-sectional survey. BMC Gastroenterol 2014; 14: 34.doi:10.1186/1471-230X-14-34

http://www.ncbi.nlm.nih.gov/pubmed/24552174

Xie

S-H.

Lagergren

. The male predominance in esophageal adenocarcinoma. Clin Gastroenterol Hepatol 2016; 14: 338–347.doi:10.1016/j.cgh.2015.10.005

http://www.ncbi.nlm.nih.gov/pubmed/26484704

Zhang

. Epidemiology of esophageal cancer. World J Gastroenterol 2013; 19: 5598–5606.doi:10.3748/wjg.v19.i34.5598

http://www.ncbi.nlm.nih.gov/pubmed/24039351

National Institute of Diabetes & Digestive & Kidney Diseases . Overweight & obesity statistics, https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity (2017, accessed March 1, 2019).

10.

GW.

Situ

DR.

et al. Three-field vs two-field lymph node dissection for esophageal cancer: a meta-analysis. Ann Thorac Surg 2014; 97: 1658–1950.

11.

Zhou

et al. Diabetes mellitus carries a risk of esophageal cancer: a meta-analysis. Medicine 2017; 96: e7944.doi:10.1097/MD.0000000000007944

http://www.ncbi.nlm.nih.gov/pubmed/28858123

12.

Wang

YR.

Fisher

RS.

Parkman

. Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995-2004. Am J Gastroenterol 2008; 103: 313–322.doi:10.1111/j.1572-0241.2007.01658.x

http://www.ncbi.nlm.nih.gov/pubmed/18047541

13.

R Core Team . R: A language and environment for statistical computing. R Foundation for Statistical Computing, https://www.R-project.org (2015, accessed June 18, 2020).

14.

Jamie Dy

Freiberger

Liu

et al. Impact of gastroesophageal reflux and delayed gastric emptying on pediatric lung transplant outcomes. J Heart Lung Transplant 2017; 36: 854–861.doi:10.1016/j.healun.2017.01.005

http://www.ncbi.nlm.nih.gov/pubmed/28185711

15.

Lee

AL.

Goldstein

. Gastroesophageal reflux disease in COPD: links and risks. Int J Chron Obstruct Pulmon Dis 2015; 10: 1935–1949.doi:10.2147/COPD.S77562

http://www.ncbi.nlm.nih.gov/pubmed/26392769

16.

Kadakia

SC.

De La Baume

HR.

Shaffer

. Effects of transdermal nicotine on lower esophageal sphincter and esophageal motility. World J Gastroenterol 2014; 20: 18022–18030.

17.

Jamal

King

BA.

Neff

et al. Current cigarette smoking among adults—United States, 2005-2015. MMWR Morb Mortal Wkly Rep 2016; 65: 1205–1211.doi:10.15585/mmwr.mm6544a2

http://www.ncbi.nlm.nih.gov/pubmed/27832052

18.

Mohammed

Van Buren Ii

McElhany

et al. Delayed gastric emptying following pancreaticoduodenectomy: incidence, risk factors, and healthcare utilization. World J Gastrointest Surg 2017; 9: 73–81.doi:10.4240/wjgs.v9.i3.73

http://www.ncbi.nlm.nih.gov/pubmed/28396720

19.

Antonoff

MB.

Puri

Meyers

et al. Comparison of pyloric intervention strategies at the time of esophagectomy: is more better? Ann Thorac Surg 2014; 97: 1950–1958.doi:10.1016/j.athoracsur.2014.02.046

http://www.ncbi.nlm.nih.gov/pubmed/24751155

20.

Giugliano

DN.

Berger

AC.

Meidl

et al. Do intraoperative pyloric interventions predict the need for postoperative endoscopic interventions after minimally invasive esophagectomy? Dis Esophagus 2017; 30: 1–8.doi:10.1093/dote/dow034

http://www.ncbi.nlm.nih.gov/pubmed/28375478

21.

Bolton

JS.

Conway

WC.

Abbas

. Planned delay of oral intake after esophagectomy reduces the cervical anastomotic leak rate and hospital length of stay. J Gastrointest Surg 2014; 18: 304–309.doi:10.1007/s11605-013-2322-2

http://www.ncbi.nlm.nih.gov/pubmed/24002761

22.

Wente

MN.

Bassi

Dervenis

et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007; 142: 761–768.doi:10.1016/j.surg.2007.05.005

23.

Malleo

Crippa

Butturini

et al. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors. HPB 2010; 12: 610–618.doi:10.1111/j.1477-2574.2010.00203.x

20961369

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.12 MB

0.00 MB