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2010 Annual Meeting Abstracts

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Endoscopic Pyloric Balloon Dilatation Obviates the Need for Pyloroplasty at Esophagectomy
*Edward W Swanson1, Scott J Swanson1,2, Richard S Swanson1,2
1Harvard Medical School, Boston, MA;2Brigham and Women's Hospital, Boston, MA

Objective: Because the acquired pyloric stenosis (APS) rate from truncal vagotomy is 15%, many surgeons perform a pyloroplasty or pyloromyotomy at the time of esophagectomy. Endoscopic pyloric balloon dilatation (EPBD) is another method to manage APS. This study will evaluate a cohort treated with preoperative EPBD.
Design: Retrospective review of case series from 2002 to 2009
Setting: Brigham and Women’s Hospital, a tertiary care center.
Patients: 25 patients (80% male; median age 63 years [range 47-81])
Interventions: All patients had outpatient preoperative EPBD and esophagectomies one to two weeks later. None had pyloroplasties or pyloromyotomies at the time of esophagectomy. Selected patients had postoperative endoscopy.
Main Outcome Measures. Need for subsequent surgery for gastric outlet obstruction. Rate of pyloric stenosis noted on postoperative endoscopy.
Results: Of the 25 patients, 20 had transhiatal esophagectomies, 3 had thoracoabdominal esophagectomies, and 2 had VATS 3-hole esophagectomies. Median follow-up time was 17 months (range 1-75). There were no complications from EPBD. There were no postoperative deaths. No patient needed a second operation for gastric outlet obstruction. All patients had postoperative barium swallows (BaS) or endoscopy or both. Only one patient (4%) required one postoperative EPBD to dilate a 16 mm pylorus. Three others had delayed gastric emptying on BaS with endoscopy showing each pylorus was wide open. Their symptoms improved with time.
Conclusions: In this small cohort, preoperative EPBD in all patients combined with postoperative EPBD in one patient obviated the need for pyloroplasty. This approach merits further study in a larger cohort particularly to determine whether preoperative EPBD is necessary or if only selected postoperative EPBD is sufficient.

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