Sivakumar Jonathan, Alnimri Feras, Liu David S, Duong Cuong Phu
Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Surgery, The University of Melbourne, Melbourne, Australia.
Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
J Gastrointest Surg. 2025 Jun;29(6):102046. doi: 10.1016/j.gassur.2025.102046. Epub 2025 Apr 1.
Delayed gastric conduit emptying (DGCE) is a common functional complication after esophagectomy that significantly impairs the quality of life. Despite its clinical burden, standardized management protocols are lacking, and treatment approaches often rely on individual surgeon preference. This review aimed to evaluate the evidence on procedural interventions for established late DGCE to inform clinical decision-making.
A systematic review was conducted across 5 databases, identifying 26 studies on DGCE interventions. Studies were assessed for quality using the Newcastle-Ottawa Scale, emphasizing the inclusion criteria that focused on procedural efficacy and outcome reporting.
A total of 26 studies encompassing diverse treatment modalities were included. Endoscopic approaches, such as botulinum toxin injection and balloon dilatation, have emerged as preferred first-line interventions, with success rates ranging from 50.0% to 100.0%. A hybrid approach combining both modalities demonstrated enhanced efficacy and lower recurrence, with success rates reaching 100.0%. Gastric peroral endoscopic myotomy showed promise for treatment-resistant DGCE, with experienced centers reporting success in 77.2% of refractory cases. Surgical options for gastric conduit revision were reserved for cases of DGCE with structural abnormalities, although the surgical options were associated with higher risks and complications. Significant heterogeneity in outcome definitions and reporting limited the comparability between studies.
This comprehensive evaluation provides valuable insights to assist clinicians in navigating current management strategies for DGCE. High-quality comparative studies are essential to refine treatment protocols and improve long-term patient outcomes.
胃代食管延迟排空（DGCE）是食管切除术后常见的功能性并发症，严重影响生活质量。尽管其临床负担较重，但缺乏标准化的管理方案，治疗方法往往依赖于外科医生的个人偏好。本综述旨在评估已确诊的晚期DGCE的手术干预证据，为临床决策提供参考。
对5个数据库进行系统综述，确定了26项关于DGCE干预的研究。使用纽卡斯尔-渥太华量表评估研究质量，重点关注侧重于手术疗效和结果报告的纳入标准。
共纳入26项涵盖多种治疗方式的研究。内镜治疗方法，如肉毒杆菌毒素注射和球囊扩张，已成为首选的一线干预措施，成功率在50.0%至100.0%之间。两种方式结合的混合治疗方法显示出更高的疗效和更低的复发率，成功率达到100.0%。经口内镜下胃肌切开术对难治性DGCE显示出治疗前景，经验丰富的中心报告难治性病例的成功率为77.2%。胃代食管修复的手术选择仅适用于存在结构异常的DGCE病例，尽管手术选择与更高的风险和并发症相关。结果定义和报告方面的显著异质性限制了研究之间的可比性。
这项综合评估提供了有价值的见解，以帮助临床医生制定当前DGCE的管理策略。高质量的比较研究对于完善治疗方案和改善患者长期预后至关重要。
