Nevo Yehonatan, Calderone Alexander, Kammili Anitha, Boulila Cyril, Renaud Stephane, Cools-Lartigue Jonathan, Spicer Jonathan, Mueller Carmen, Ferri Lorenzo
Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, QC, Canada.
Division of Thoracic Surgery, McGill University Health Centre, 1650 Cedar Avenue, Room L8-505, Montreal, QC, H3G 1A4, Canada.
Surg Endosc. 2022 Apr;36(4):2341-2348. doi: 10.1007/s00464-021-08511-0. Epub 2021 May 4.
Pyloric drainage procedures, namely pyloromyotomy or pyloroplasty, have long been considered an integral aspect of esophagectomy. However, the requirement of pyloric drainage in the era of minimally invasive esophagectomy (MIE) has been brought into question. This is in part because of the technical challenges of performing the pyloric drainage laparoscopically, leading many surgical teams to explore other options or to abandon this procedure entirely. We have developed a novel, technically facile, endoscopic approach to pyloromyotomy, and sought to assess the efficacy of this new approach compared to the standard surgical pyloromyotomy.
Patients who underwent MIE for cancer from 01/2010 to 12/2019 were identified from a prospectively maintained institutional database and were divided into two groups according to the pyloric drainage procedure: endoscopic or surgical pyloric drainage. 30-day outcomes (complications, length of stay, readmissions) and pyloric drainage-related outcomes [conduit distension/width, nasogastric tube (NGT) duration and re-insertion, gastric stasis] were compared between groups.
94 patients were identified of these 52 patients underwent endoscopic PM and 42 patients underwent surgical PM. The groups were similar with respect to age, gender and comorbidities. There were more Ivor-Lewis esophagectomies in the endoscopic PM group than the surgical PM group [45 (86%), 15 (36%) p < 0.001]. There was no significant difference in the rate of complications and readmissions. Gastric stasis requiring NGT re-insertion was rare in the endoscopic PM group and did not differ significantly from the surgical PM group (1.9-4.7% p = 0.58).
Endoscopic pyloromyotomy using a novel approach is a safe, quick and reproducible technique with comparable results to a surgical PM in the setting of MIE.
幽门引流手术，即幽门肌切开术或幽门成形术，长期以来一直被视为食管切除术不可或缺的一部分。然而，在微创食管切除术（MIE）时代，幽门引流的必要性受到了质疑。部分原因是腹腔镜下进行幽门引流存在技术挑战，导致许多手术团队探索其他选择或完全放弃该手术。我们开发了一种新颖、技术上简便的内镜下幽门肌切开术方法，并试图评估这种新方法与标准手术幽门肌切开术相比的疗效。
从一个前瞻性维护的机构数据库中识别出2010年1月至2019年12月期间因癌症接受MIE的患者，并根据幽门引流手术分为两组：内镜下或手术幽门引流。比较两组的30天结局（并发症、住院时间、再入院）和幽门引流相关结局[管道扩张/宽度、鼻胃管（NGT）留置时间和重新插入、胃潴留]。
共识别出94例患者，其中52例接受内镜下幽门肌切开术，42例接受手术幽门肌切开术。两组在年龄、性别和合并症方面相似。内镜下幽门肌切开术组的Ivor-Lewis食管切除术比手术幽门肌切开术组多[45例（86%），15例（36%），p<0.001]。并发症和再入院率无显著差异。内镜下幽门肌切开术组需要重新插入NGT的胃潴留很少见，与手术幽门肌切开术组无显著差异（1.9%-4.7%，p=0.58）。
采用新颖方法的内镜下幽门肌切开术是一种安全、快速且可重复的技术，在MIE背景下与手术幽门肌切开术效果相当。
