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Updated: May 1, 2026
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Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy
Published on: August 22, 2025
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Delayed gastric emptying after esophagectomy for malignancy.
Bin Li1, Jian-Hua Zhang, Cheng Wang
1Department of Thoracic Surgery, Lanzhou University Second Hospital , Lanzhou University Second Clinical Medical College, Lanzhou, People's Republic of China .
Summary
Omitting pyloric drainage after esophagectomy with a gastric conduit does not increase delayed gastric emptying (DGE). Many DGE cases resolve with conservative management or endoscopic balloon pyloric dilatation, proving routine drainage is unnecessary.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Esophageal Surgery
Background:
- Pyloric drainage after esophagectomy with gastric conduit is debated.
- Potential benefits include preventing delayed gastric emptying (DGE), but risks include dumping syndrome and bile reflux.
Purpose of the Study:
- To audit the incidence and management of DGE in patients undergoing esophagectomy without routine pyloric drainage.
Main Methods:
- Retrospective review of 356 patients undergoing esophagectomy with gastric conduit reconstruction without pyloric drainage.
- Analysis of DGE incidence, management strategies, and outcomes.
Main Results:
- Overall DGE incidence was 15.7%, with no demographic or intraoperative differences between groups.
- Intra-right thoracic gastric conduits were associated with higher DGE rates (P=.031).
- Endoscopic balloon dilatation achieved a 78.9% success rate for DGE management.
Conclusions:
- Routine operative pyloric drainage is not necessary after esophagectomy with gastric conduit.
- Conservative management and endoscopic balloon pyloric dilatation are effective for postoperative DGE.
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