Peristalsis of the gastric conduit post-esophagectomy: is it relevant? Detailed conduit analysis using dynamic...

The incidence of esophageal cancer resections is rising, and survivorship improving. Consequently, more patients are living longer with gastric conduits and enduring the associated morbidity. Gastric conduit shape and peristalsis are believed to mediate conduit function, gastrointestinal symptoms, and quality of life (QoL). However, the relationship between anatomical variations, peristaltic function, and conduit emptying remains largely undefined. This prospective observational study recruited patients with gastric conduits at least 2 years post-esophagectomy and controls with normal gastric anatomy. Dynamic and static MRI sequences were obtained following porridge ingestion. Nuclear scintigraphy conduit emptying studies were available for 17 out of 18 (94%) patients. QoL questionnaire data were collected. Eighteen patients with conduits and 12 controls were recruited. Peristalsis was measurable in 15 conduits. There was no difference in peristaltic wave frequency between conduits and controls (5 waves per 90 seconds in each group) or median Gastric Motility Index Interquartile Range (IQR) 35.45 mm2/second (17.3-47.5) vs 36.5 mm2/second (9.8-99.4) p = 0.61. Gastric emptying was significantly reduced in conduit patients (0.10% vs 15% p = 0.01). Acute angulation and conduits wider than 4 cm were associated with slower emptying (444 minutes vs 127 minutes, p = 0.025) and (286 minutes vs 76 minutes, p = 0.02), respectively. Delayed emptying demonstrated a significant positive correlation with reflux (rs0.614, p = 0.009) and increased gastrointestinal symptoms (rs0.553, p = 0.021). Peristalsis is present in most conduits, but it does not correlate with improved emptying. Anatomical features, particularly conduit angulation and width influence conduit function. These findings may guide further research into optimizing conduit formation and treating dysfunction.