Management of delayed gastric conduit emptying after esophagectomy

Esophagectomy is undoubtedly the mainstay curative therapy for resectable esophageal cancer. However, the morbidity and mortality rates of esophagectomy are relatively high compared to other gastrointestinal surgeries. Delayed gastric emptying (DGE) is one of the major complications occurring in 15–39% patients after esophagectomy despite recent progress in anesthesia and surgical techniques (1-3). It is widely believed that bilateral vagotomy and increased pyloric resistance are the major culprits of DGE after esophagectomy. Patients suffering from DGE mainly complain of nausea, vomiting, anorexia, early satiety, bloating and abdominal pain, but without any evidence of mechanical obstruction from CT/MR enterography. DGE can be further confirmed by scintigraphy in clinically suspected patients (4). More importantly, DGE increases the risk of aspiration pneumonia and anastomosis leak