Background/Objectives: Delayed gastric conduit emptying (DGCE) occurs in 15–39% of patients who undergo esophagectomy. Intra-Pyloric Injection of Botulinum Toxin (IPBT), Pneumatic Balloon Dilation (PBD), and the same session combination (BTPD) represent the main endoscopic procedures, but comparative data are currently unavailable.Methods: We retrospectively analyzed prospectively collected data on all consecutive patients with DGCE treated endoscopically with IPBT, PBD, or BTPD. ISDE Diagnostic Criteria were used for DGCE diagnosis and classification. A Gastric Outlet Obstruction Score was used for clinical staging. All patients undergoing IPBT received 100 UI of toxin, while those undergoing PBD were dilated up to 20 mm. Clinical success (CS) was defined as the resolution of symptoms/resumption of feeding at discharge or expanding dietary intake at any rate. Recurrence was defined as symptom relapse after more than 15 days of well-being requiring endoscopic/surgical intervention.Results: A total of 64 patients (81.2% male, 90.6% Ivor-Lewis esophagectomy, 77.4% adenocarcinoma) with a median age of 62 years (IQR 55–70) were enrolled: 18 (28.1%) in the IPBT group, 24 (37.5%) in the PBD group, and 22 (34.4%) in the BTPD group. No statistically significant differences were found in the baseline characteristics, surgical techniques, and median follow-up among the three groups. BTPD showed a higher CS rate (100%) compared to the PD and BTPD groups (p= 0.02), and a Kaplan–Meier analysis with a log–rank test revealed that the BTPD group was associated both with a significatively shorter mean time to refeed of 1.16 days (95% CI 0.8–1.5;p= 0.001) and a shorter median time to discharge of one day (95% CI 1–3;p= 0.0001).Conclusions: Endoscopic management of DGCE remains challenging. Waiting for further strong evidence, BTPD can offer patients a higher clinical efficacy rate and a shorter time to refeed and be discharged.
背景/目的：食管切除术后患者中15-39%会发生胃代食管排空延迟。幽门内注射肉毒毒素、球囊扩张术及同期联合治疗是目前主要的内镜干预手段，但尚缺乏对比研究数据。方法：我们回顾性分析了连续接受上述三种内镜治疗的胃代食管排空延迟患者的前瞻性数据。采用国际食管疾病学会诊断标准进行胃代食管排空延迟的诊断与分型，使用胃流出道梗阻评分系统进行临床分期。所有接受肉毒毒素注射的患者均使用100单位毒素，球囊扩张组均扩张至20毫米。临床成功定义为出院时症状缓解/恢复进食或饮食摄入量任何程度的增加。复发定义为症状缓解超过15天后再次出现症状并需内镜或外科干预。结果：共纳入64例患者（男性81.2%，Ivor-Lewis术式90.6%，腺癌77.4%），中位年龄62岁（四分位距55-70岁）：肉毒毒素组18例（28.1%），球囊扩张组24例（37.5%），联合治疗组22例（34.4%）。三组间基线特征、手术方式及中位随访时间均无统计学差异。联合治疗组临床成功率（100%）显著高于其他两组（p=0.02），Kaplan-Meier分析显示联合治疗组实现再喂养的平均时间显著缩短1.16天（95%CI 0.8-1.5；p=0.001），中位住院时间缩短1天（95%CI 1-3；p=0.0001）。结论：胃代食管排空延迟的内镜治疗仍具挑战性。在获得更强证据前，联合治疗可为患者提供更高的临床有效率、更快的再喂养时间和更短的住院时间。
肿瘤(癌症)患者之家