Balloon Dilatation of the Pylorus After Gastric Pull-up in a Single Centre

Abstract

Background: The mainstay of intended curative treatment for esophagus cancer is surgery. Symptoms of gastric outlet obstruction can occur in some patients postoperatively. Some of these patients require alleviating treatment which may include balloon dilatation of the pylorus. The aim of this study was to investigate the use for balloon dilatation of the pylorus following esophagectomy in patients treated for carcinoma of the esophagus with intent to cure. Methods: A retrospective study of 120 patients who underwent esophagectomy with gastric pull-up at Aarhus University Hospital, Denmark, between January 2017 and December 2018 and were followed until December 2020. Primary outcome was number of postoperative balloon dilatations of the pylorus. Results: A total of 63 patients (53%) went through at least 1 balloon dilatation of the pylorus, 40 (63%) needed more than 1 dilatation. The median time between esophagectomy and first dilatation was two months. There was a strong association between squamous cell carcinoma and postoperative dilatation compared to adenocarcinoma (OR=4.13). An association was also seen between ex-smokers and postoperative dilatation compared to non-smokers (OR=3.95). Conclusions: More than fifty percent of the patients needed postoperative balloon dilatation. The need for dilatations was strongest between the second and the ninth postoperative month. A nationwide multicentre study of gastric pull-up patients is needed in the future to develop clinical tools to assess the need for pyloric dilatation.