Intrapyloric Botulinum Injection Increases Postoperative Esophagectomy Complications

Eldaif, Shady M.; Lee, Richard; Adams, Kumari N.; Kilgo, Patrick D.; Gruszynski, Mark A.; Force, Seth D.; Pickens, Allan; Fernández, Félix G.; Luu, Theresa D.; Miller, Daniel

doi:10.1016/j.athoracsur.2013.11.026

Cited by 34 publications

(16 citation statements)

References 14 publications

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“…In contrast, Eldaif et al found that patients receiving botulinum injections exhibited a higher rate of postoperative reflux symptoms and increased use of promotility agents and more frequently required postoperative endoscopic interventions. Therefore, the authors concluded that intrapyloric botulinum toxin injections should not be used as an alternative to standard drainage procedures [ 33 ]. Consequently, the value of botulinum toxin injections as an alternative approach to reduce postoperative gastric outlet obstruction remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Pylorus drainage procedures in thoracoabdominal esophagectomy – a single-center experience and review of the literature

et al. 2018

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BackgroundPylorotomy and pyloroplasty in thoracoabdominal esophagectomy are routinely performed in many high-volume centers to prevent delayed gastric emptying (DGE) due to truncal vagotomy. Currently, controversy remains regarding the need for these practices. The present study aimed to determine the value and role of pyloric drainage procedures in esophagectomy with gastric replacement.MethodsA retrospective review of prospectively collected data was performed for all consecutive patients who underwent thoracoabdominal resection of the esophagus between January 2009 and December 2016 at the Katharinenhospital in Stuttgart, Germany. Clinicopathologic features and surgical outcomes were evaluated with a focus on postoperative nutrition and gastric emptying.ResultsThe study group included 170 patients who underwent thoracoabdominal esophageal resection with a gastric conduit using the Ivor Lewis approach. The median age of the patients was 64 years. Most patients were male (81%), and most suffered from adenocarcinoma of the esophagus (75%). The median hospital stay was 20 days, and the 30-day hospital death rate was 2.9%. According to the department standard, pylorotomy, pyloroplasty, or other pyloric drainage procedures were not performed in any of the patients. Overall, 28/170 patients showed clinical signs of DGE (16.5%).ConclusionsIn the literature, the rate of DGE after thoracoabdominal esophagectomy is reported to be approximately 15%, even with the use of pyloric drainage procedures. This rate is comparable to that reported in the present series in which no pyloric drainage procedures were performed. Therefore, we believe that pyloric drainage procedures may be unwarranted in thoracoabdominal esophagectomy. However, future randomized trials are needed to ultimately confirm this supposition.

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Section: Discussionmentioning

confidence: 99%

Pylorus drainage procedures in thoracoabdominal esophagectomy – a single-center experience and review of the literature

et al. 2018

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“…Theoretically, botulinum toxin could weaken the pyloric smooth muscles temporarily during the early postoperative period, and the relaxing effect might disappear along with potentially decreased bile reflux and dumping syndrome within 12 weeks. However, Eldaif et al [39] reported that although the use of IPBT significantly decreased the operative time compared to pyloromyotomy and pyloroplasty, the patients who received IPBT suffered from more reflux symptoms, had more frequent use of promotility drugs, needed more frequent endoscopic pyloric interventions, and had no benefits compared to those who underwent pyloromyotomy and pyloroplasty in terms of reducing dumping symptoms. In a well-matched cohort study, Stewart et al [40] demonstrated a similar incidence of DGE between patients who received no pyloric intervention and those who received IPBT in the setting of minimally invasive esophagectomy.…”

Section: Managementmentioning

confidence: 99%

Delayed Gastric Emptying after Esophagectomy: Management and Prevention

Yang

Choi

Kim

et al. 2020

Korean J Thorac Cardiovasc Surg

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The quality of life associated with eating is becoming an increasingly significant problem for patients who undergo esophagectomy as a result of the improved survival rate after esophageal cancer surgery. Delayed gastric emptying (DGE) is a common complication after esophagectomy. Although several strategies have been proposed for the management and prevention of DGE, no clear consensus exists. The purpose of this review is to present a brief overview of DGE and to help clinicians choose the most appropriate treatment through an analysis of DGE by cause. Furthermore, we would like to suggest some tips to prevent DGE based on our experience.

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“…Preliminary case series showed that IBTJ could be safely performed in esophagectomy patients (15,16) and a comparative study recommended IBTJ over pyloroplasty based on similar effect with simpler technique and less pyloric damage (17). However, further study found that although IBTJ might significantly decrease operative time, patients receiving IBTJ experienced more DGE and reflux compared to the ones receiving pyloroplasty or pyloromyotomy (18). Furthermore, a study doubted the necessity of IBTJ in minimally invasive esophagectomy patients as both IBTJ and no-intervention controlled group had low incidence of DGE (IBTJ: 8.6%, 3/35 vs.…”

Section: Ibtjmentioning

confidence: 99%

Management of delayed gastric conduit emptying after esophagectomy

Zhang¹

2019

J. Thorac. Dis

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Delayed gastric conduit emptying (DGE) is a common complication after esophagectomy. Currently, pyloric interventions are the major prevention and treatment for DGE. In this review, we attempt to evaluate the clinical effect and safety of different pyloric interventions in esophagectomy patients. Moreover, other important management of DGE, including size of esophageal substitute, erythromycin and nasogastric tube (NGT) will also be discussed.

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Intrapyloric Botulinum Injection Increases Postoperative Esophagectomy Complications

Cited by 34 publications

References 14 publications

Pylorus drainage procedures in thoracoabdominal esophagectomy – a single-center experience and review of the literature

Pylorus drainage procedures in thoracoabdominal esophagectomy – a single-center experience and review of the literature

Delayed Gastric Emptying after Esophagectomy: Management and Prevention

Management of delayed gastric conduit emptying after esophagectomy

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