PD02.04. Persistent Gastric Conduit Electrophysiological Abnormalities After Esophagectomy Assessed by High-Resolution Body Surface Mapping

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ID: 326000
2026
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Ranked #443 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes Background Delayed gastric conduit emptying and functional morbidity remain common after esophagectomy, yet the underlying physiologic mechanisms are incompletely defined. This study characterized gastric conduit electrophysiology using high-resolution body surface gastric mapping and examined associations with symptoms, delayed gastric conduit emptying (DGCE), and clinical outcomes. Methods Thirty adults ≥12 months following Ivor Lewis esophagectomy were prospectively enrolled and compared with 30 matched controls. Participants underwent fasting and 4-hour postprandial high-resolution body surface gastric mapping using a 64-channel array. Spectral metrics included principal gastric frequency, BMI-adjusted amplitude, and Gastric Alimetry Rhythm Index (GA-RI). Patient-reported outcomes were assessed using PAGI-SYM, PAGI-QoL, total symptom burden score (TSBS), and Konradsson’s DGCE grading tool. Electrophysiologic phenotypes were classified according to validated criteria. Between-group comparisons used paired statistical testing. Associations between electrophysiologic parameters, symptom burden, and DGCE were assessed using Pearson correlation and ANOVA with correlation ratio (η). Statistical significance was defined as p<0.05. Results Post-esophagectomy patients demonstrated significantly reduced principal gastric frequency (2.65±0.37 vs 3.11±0.24 cpm; p<0.0001) and BMI-adjusted amplitude (27.1±11.1 vs 40.5±17.3 μV; p=0.0007) compared with controls. GA-RI did not differ significantly. Twenty-three patients (76.7%) exhibited abnormal electrophysiologic phenotypes, predominantly low-frequency activity. Symptom burden was significantly greater in patients, with worse PAGI-SYM, PAGI-QoL, and TSBS scores (all p<0.01). DGCE was present in 7 patients (23.3%) and correlated strongly with symptom severity (PAGI-SYM r=0.72) and quality-of-life impairment (r=–0.54). Principal gastric frequency correlated with nausea (r=0.49), while BMI-adjusted amplitude correlated with excessive fullness (r=0.49) and upper gastrointestinal pain (r=0.48). Conclusion The gastric conduit exhibits reproducible and clinically relevant electrophysiologic abnormalities years after esophagectomy. These objective phenotypes correlate with symptom burden and offer mechanistic insight beyond conventional clinical assessment. High-resolution body surface gastric mapping represents a novel and scalable platform for physiologic stratification, with potential to guide personalized, mechanism-based management in post-esophagectomy patients.
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Authors Tim Hsu-Han Wang, Jonathan Sivakumar, Ashraf Tokhi, Greg O'Grady, Cuong P Duong
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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/doag077.082
URL
https://doi.org/10.1093/dote/doag077.082
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