Delayed gastric conduit emptying after esophagectomy: attempt at a clinically relevant classification

Delayed gastric conduit emptying (DGCE) is a common functional syndrome after esophagectomy. The clinical phenotype is characterized by regurgitation, reflux, and the inability to meet caloric requirements by oral intake. Diagnosis and cause-directed therapy are often challenging because of variable underlying pathomechanisms. Against this background and based on our clinical experience, we propose a classification that categorizes DGCE according to the predominant case-specific pathophysiology: Class I: functional-DGCE due to impaired antro-pyloric motilityClass II: conduit-related-DGCE caused by specific patho-anatomical features of the conduitClass III: hiatal-DGCE resulting from mechanical obstruction at the diaphragmatic hiatusClass IV: other-Other causes of DGCE at or distal to the pylorus (e.g. luminal occlusion, intestinal adhesions or peritoneal carcinomatosis) We believe that this classification has the potential to promote a better understanding of the symptom spectrum of DGCE and to facilitate cause-oriented, focused treatment. Moreover, we are convinced that a structured definition of DGCE according to pathophysiology will improve the comparability of different patient cohorts and thus promote future collaborative research.