Harvard Medical School, Boston, MA, USA.
Surg Endosc. 2012 Jul;26(7):2023-8. doi: 10.1007/s00464-012-2151-5. Epub 2012 Mar 8.
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.
由于迷走神经切断术后获得性幽门狭窄（APS）的发生率为 15%，许多外科医生在进行食管切除术时会同时进行幽门成形术或幽门肌切开术。内镜下幽门球囊扩张术（EPBD）是另一种治疗 APS 的方法。本研究评估了一组接受术前 EPBD 治疗的患者。
这是对 2002 年至 2009 年在布莱根妇女医院接受术前 EPBD 和食管癌切除术的所有患者进行的回顾性分析，该医院是一家三级护理中心。主要研究终点为因胃出口梗阻而需要进一步手术的比例、术后内镜检查发现幽门狭窄的发生率以及并发症。
对该系列研究进行回顾，25 例患者（80%为男性；中位年龄为 63 岁[范围 47-81 岁]）在门诊接受 EPBD 治疗，并在 1-2 周后接受食管切除术，且均纳入本研究。这些患者在进行食管切除术时均未行幽门成形术或幽门肌切开术。部分患者术后进行了内镜检查。25 例患者中，20 例行经胸食管切除术，3 例行胸腹联合食管切除术，2 例行 VATS 三孔食管切除术。中位随访时间为 22 个月（范围 1-84 个月）。EPBD 无并发症。无术后死亡病例。无患者因胃出口梗阻而需要二次手术。所有患者均进行了钡餐（BaS）或内镜检查，或两者兼有。仅有 1 例患者（4%）需要进行一次术后 EPBD 以扩张 16mm 的幽门。另外 3 例患者钡餐显示胃排空延迟，但内镜下发现每个幽门均完全开放。他们的症状随时间推移而改善。
在本队列中，所有患者均接受术前 EPBD 治疗，1 例患者接受术后 EPBD 治疗，避免了行幽门成形术的需要。这一方法值得在更大的队列中进一步研究，特别是要确定术前 EPBD 是否有必要，或者仅选择性的术后 EPBD 是否足够。
