Maus Martin K H, Leers Jessica, Herbold Till, Bludau Marc, Chon Seung-Hun, Kleinert Robert, Hescheler Daniel A, Bollschweiler Elfriede, Hölscher Arnulf H, Schäfer Hartmut, Alakus Hakan
Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
World J Surg. 2016 Oct;40(10):2405-11. doi: 10.1007/s00268-016-3575-1.
Delayed gastric emptying after esophagectomy with gastric replacement can pose a significant postoperative problem, often leading to aspiration and pneumonia. The present study analyzes retrospectively the effectiveness of endoscopic pyloric dilatation for post-surgical gastric outlet obstruction.
Between March 2006 and March 2010, 403 patients underwent a transthoracic en-bloc esophagectomy and reconstruction with a gastric tube and intrathoracic esophagogastrostomy. In patients with postoperative symptoms of an outlet dysfunction and the confirmation by endoscopy, pyloric dilatations were performed without preference with either 20- or 30-mm balloons.
A total of 89 balloon dilatations of the pylorus after esophagectomy were performed in 60 (15.6 %) patients. In 21 (35 %) patients, a second dilatation of the pylorus was performed. 55 (61.8 %) dilatations were performed with a 30-mm balloon and 34 (38.2 %) with a 20-mm balloon. The total redilatation rate for the 30-mm balloon was 20 % (n = 11) and 52.9 % (n = 18) for the 20-mm balloon (p < 0.001). All dilatations were performed without any complications.
Pylorus spasm contributes to delayed gastric emptying leading to postoperative complications after esophagectomy. Endoscopic pyloric dilatation after esophagectomy is a safe procedure for treatment of gastric outlet obstruction. The use of a 30-mm balloon has the same safety profile but a 2.5 lower redilatation rate compared to the 20-mm balloon. Thus, the use of 20-mm balloons has been abandoned in our clinic.
食管切除胃代食管术后胃排空延迟是一个严重的术后问题，常导致误吸和肺炎。本研究回顾性分析内镜下幽门扩张术治疗术后胃出口梗阻的有效性。
2006年3月至2010年3月，403例患者接受了经胸整块食管切除、胃管重建及胸内食管胃吻合术。对于有术后出口功能障碍症状且经内镜证实的患者，使用20mm或30mm球囊进行幽门扩张术，无偏好选择。
60例（15.6%）患者共进行了89次食管切除术后幽门球囊扩张术。21例（35%）患者进行了第二次幽门扩张术。55次（61.8%）扩张使用30mm球囊，34次（38.2%）使用20mm球囊。30mm球囊的再扩张率为20%（n = 11），20mm球囊为52.9%（n = 18）（p < 0.001）。所有扩张均无并发症发生。
幽门痉挛导致胃排空延迟，进而引起食管切除术后的并发症。食管切除术后内镜下幽门扩张术是治疗胃出口梗阻的安全方法。使用30mm球囊与20mm球囊安全性相同，但再扩张率低2.5倍。因此，我们诊所已不再使用20mm球囊。
