PD09.04. Prophylactic Pyloric Dilatation and Its Impact on Early Delayed Conduit Emptying and Pneumonia Post-Oesophagectomy for Cancer: A Multi-Centre Cohort Study

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ID: 325968
2026
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Abstract
Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Background Early delayed conduit emptying and pneumonia are the most common complications following oesophagectomy, potentially resulting in significant morbidity and prolonged hospitalisation. Pyloroplasty or pyloromyotomy is challenging to perform with the increasing adoption of minimally invasive oesophagectomy. Here, we evaluate the therapeutic utility of prophylactic pyloric dilation in patients undergoing oesophagectomy. Methods We retrospectively reviewed consecutive oesophagectomies for cancer undertaken at two Australian tertiary hospitals from January 2017 to December 2025. Data was collected prospectively as part of our unit registries. Since 2023, endoscopic-assisted pyloric dilatation was performed routinely for all oesophagectomies, at the beginning of each case, using 20mm (2 minutes) balloons. Our primary endpoint was the rate of post-operative delayed conduit emptying and pneumonia. Secondary endpoints included: nasogastric outputs, duration of nasogastric tube decompression, post-operative complications, as well as ICU and hospital length-of-stay. Delayed conduit emptying was defined as >500ml nasogastric output on post-operative day (POD) 5-14 or ≥2-fold increase in conduit width and air-fluid level evident on CXR at POD 5-14 compared with POD 0. Pneumonia and other complications were defined by the Esophagectomy Complication Consensus Guidelines. Patients who did and did not (controls) receive pyloric dilatation were compared, with findings validated using multivariate regression and propensity-score matched analyses. Results In total, 187 oesophagectomies were analysed, 40 received pyloric dilatation. Compared to controls, pyloric dilatation was associated with lower post-operative nasogastric outputs [mean (SEM) ml, POD4: 238.2 (44.0) vs 130.0 (27.2) p=0.040, POD5: 197.1 (29.2) vs 93.8 (38.1) p=0.034, POD6: 156.2 (28.2) vs 59.6 (31.3) p=0.024], earlier nasogastric tube removal [median (IQR) day, 6 (4-11) vs 4 (3-7) p=0.032], and decreased rates of delayed conduit emptying (40% vs 15%, OR 0.26 95%CI 0.11-0.65). Additionally, patients who received pyloric dilatation had reduced rates of pneumonia (41% vs 20%, OR 2.76, 95%CI 1.24-6.02), lower number of intercurrent post-operative complications [median (IQR), 1 (0-3) vs 1 (0-2), p=0.034], and shorter ICU [median (IQR), 2 (1-4) vs 1 (1-3), p=0.074] as well as hospital [median (IQR), 13 (9-22) vs 9 (8-16), p=0.007] length-of-stay. On multivariate analysis, pyloric dilatation independently predicted against delayed conduit emptying (OR 0.33, 95%CI 0.12-0.91) and pneumonia (OR 0.18, 95%CI 0.05-0.67). Conclusion Pyloric dilatation was associated with lower rates of early delayed conduit emptying and pneumonia following oesophagectomy in our cohort. This enabled earlier nasogastric tube removal and reduced hospital length-of-stay. Our findings support the use of pyloric dilatation in clinical practice to minimize the risk of early delayed conduit emptying and pneumonia. Randomised trials are ongoing to further evaluate the role of prophylactic pyloric dilatation in patients undergoing oesophagectomy.
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Authors Jonathan Sivakumar, Shaun Chew, Amass Zheng, Cuong P Duong, John Spillane, Ahmad Aly, David S Liu
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.143
URL
https://doi.org/10.1093/dote/doag077.143
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