P1173 - Functional Outcomes of Gastric Conduit Post-Esophagectomy

Presenting Author(s)

• JL

  Justin Lewis, MD

  Portland, Oregon

Justin Lewis, MD, Benjamin Yip, MD, Kyla Siemens, BS, Charlie Borzy, BS, Sarah Diamond, MD, James Dolan, MD, Fouad Otaki, MD

Oregon Health & Science University, Portland, OR

Introduction: Esophagectomy and gastric conduit formation is the standard of care for most esophageal cancers. Studies have evaluated different surgical techniques to reduce complications of delayed gastric emptying (DGE), reflux, and dumping syndrome, but few studies have assessed the functional outcomes of dysphagia, nausea, or vomiting post-esophagectomy. Our study evaluated the rate of functional conduit malfunction in patients who underwent an esophagectomy, and the response to medical, endoscopic, and surgical treatments. We hope this data will ultimately help standardize pre- and post-surgical management for such patients.

Methods: We performed a single-center retrospective review of patients with esophageal cancer treated with esophagectomy and gastric conduit formation from 2016 - 2018. Patients with prior esophagogastric surgery, underlying dysmotility disorders, and recurrence of disease were excluded. Data was case matched with asymptomatic patients post-esophagectomy. Our primary endpoint was the development of conduit malfunction symptoms (defined as patients who underwent upper endoscopy or esophagram for symptoms, as well as patients who received medical treatment for dysphagia, nausea, vomiting, and DGE). Secondary endpoints included medical, endoscopic, and surgical treatments for esophageal symptoms.

Results: 50/75 patients who underwent esophagectomy in the 2-year study period were symptomatic. Symptomatic patients had greater BMI, but had comparable demographics, tumor biology, treatment, and histological features (Table 1). Initial treatment for the majority of patients was adjustment of prokinetics; some received endoscopy and few underwent revision surgery (Figure 1). Partial and complete response to medical therapy was 64% and 14%, respectively. The most common endoscopic intervention was pyloric balloon dilation, followed by stent placement; 62.5% had partial response, and only 8% full response. Only 1 out of 4 patients who underwent revision surgery had complete resolution of symptoms. There were no significant predictors of symptoms on univariate analysis.

Discussion: The majority of patients who underwent esophagectomy with gastric conduit formation for esophageal cancer developed nausea, vomiting, dysphagia, or DGE. A minority of patients had complete response to endoscopic or surgical treatment for these symptoms. Future studies should identify predictors of symptoms to help risk stratify patients with high morbidity post-esophagectomy.

Disclosures:

Citation: Justin Lewis, MD, Benjamin Yip, MD, Kyla Siemens, BS, Charlie Borzy, BS, Sarah Diamond, MD, James Dolan, MD, Fouad Otaki, MD. P1173 - FUNCTIONAL OUTCOMES OF GASTRIC CONDUIT POST-ESOPHAGECTOMY. Program No. P1173. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.