Intra-operative Prophylactic Pyloric Balloon Dilatation During Oesophagectomy to Prevent Early Delayed Gastric Emptying
Early delayed gastric emptying (DGE) occurs in 27% of patients undergoing an Oesophagectomy in University Hospital Plymouth (UHP) as per our local definition. It has a profound effect on patients’ recovery and may lead to anastomotic leak and pneumonia. Pyloric balloon dilatation (PBD) is a recognised treatment of this complication. Preventative measures such as pyloroplasty, pyloromyotomy and pyloric Botox® injection have all been employed. Recent data however suggest none of these treatments have a significant effect in preventing DGE. In Chapter 3, a meta-analysis of observational studies showed prophylactic PBD, when compared to no intervention, had a significantly decreased the rate of DGE post oesophagectomy [16.27% vs. 39.02% (P< 0.01)]. There has not been a standardised definition of DGE until recently. This international expert consensus (IEC) definition was done by a Delphi process and has not been validated locally. In UHP, there has been a local definition of DGE used. A comparison between the two defintions was carried out restrospectively (Chapter 4). The defintions were comaparable but identified different patients.The safety of PBD was then formally assessed and confirmed (Chapter 5). There are currently no RCTs in the subject. The aim of this thesis was to ascertain the feasibility of a randomised controlled trial (RCT), to assess whether prophylactic PBD has a significant effect in reducing DGE rates post oesophagectomy. A feasibility RCT comparing the effect on DGE post oesophagectomy between prophylactic PBD and no intervention (control) was successfully achieved (Chapters 6 and 7). This therefore allows for a future RCT comparing PBD with either no pyloric intervention or other pyloric interventions, with a clear definition of DGE, to be carried out.
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