Delayed gastric conduit emptying after esophagectomy: attempt at a clinically relevant classification.
Delayed gastric conduit emptying (DGCE) is a common functional syndrome after esophagectomy. The clinical phenotype is characterized by regurgitation, reflux, and the inability to meet caloric requirements by oral intake. Diagnosis and cause-directed therapy are often challenging because of variable underlying pathomechanisms. Against this background and based on our clinical experience, we propose a classification that categorizes DGCE according to the predominant case-specific pathophysiology: Class I: functional-DGCE due to impaired antro-pyloric motilityClass II: conduit-related-DGCE caused by specific patho-anatomical features of the conduitClass III: hiatal-DGCE resulting from mechanical obstruction at the diaphragmatic hiatusClass IV: other-Other causes of DGCE at or distal to the pylorus (e.g. luminal occlusion, intestinal adhesions or peritoneal carcinomatosis) We believe that this classification has the potential to promote a better understanding of the symptom spectrum of DGCE and to facilitate cause-oriented, focused treatment. Moreover, we are convinced that a structured definition of DGCE according to pathophysiology will improve the comparability of different patient cohorts and thus promote future collaborative research.
Authors
Schneider Schneider, Viggiani D'Avalos Viggiani D'Avalos, Gerdes Gerdes, Vetter Vetter, Gutschow Gutschow
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