Thoracoscopic Implant of Neurostimulator for Delayed Gastric Conduit Emptying after Esophagectomy

Emanuele Asti, Andrea Lovece, Luigi Bonavina

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background and Aims: Gastroparesis is a clinical syndrome characterized by delayed gastric emptying in the absence of mechanical outlet obstruction. Use of the denervated stomach as an esophageal substitute is a common cause of transient gastroparesis. Gastric electrostimulation through a thoracotomy approach has previously been reported to be effective in patients with medically refractory postesophagectomy gastroparesis. We report the first thoracoscopic implant of a gastric neurostimulator. Methods and Results: A 57-year-old woman underwent Ivor Lewis esophagectomy for early stage (T1N0) adenocarcinoma in 2007. She progressively developed progressive dysphagia, regurgitation, and a 29-kg weight loss. The barium swallow study and upper gastrointestinal endoscopy showed a dilated intrathoracic stomach without evidence of mechanical obstruction. Erythromycin and multiple endoscopic dilatations of the pylorus were unsuccessful, and eventually, a feeding jejunostomy was performed. At the time the patient was referred to our outpatient clinic, she was unable to eat and depended on total enteral nutrition. Computed tomography, endoscopy, and barium swallow study confirmed that there was no evidence of recurrent adenocarcinoma or mechanical gastric outlet obstruction. A gastric electrostimulator system (Enterra®) was implanted through a right thoracoscopic access and connected to the gastric conduit. At 6-month follow-up, there was a significant improvement of the total symptom score and quality of life. Conclusions: Electrostimulation of the gastric conduit after esophagectomy can safely be performed through a thoracoscopic approach and may represent a reasonable therapeutic option in patients with symptomatic and medically refractory delayed gastric emptying.

Original languageEnglish
Pages (from-to)299-301
Number of pages3
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume26
Issue number4
DOIs
Publication statusPublished - Apr 1 2016

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Esophagectomy
Gastric Emptying
Stomach
Gastroparesis
Barium
Deglutition
Adenocarcinoma
Gastric Outlet Obstruction
Jejunostomy
Gastrointestinal Endoscopy
Pylorus
Enteral Nutrition
Erythromycin
Thoracotomy
Deglutition Disorders
Ambulatory Care Facilities
Endoscopy
Weight Loss
Dilatation
Tomography

ASJC Scopus subject areas

  • Surgery

Cite this

Thoracoscopic Implant of Neurostimulator for Delayed Gastric Conduit Emptying after Esophagectomy. / Asti, Emanuele; Lovece, Andrea; Bonavina, Luigi.

In: Journal of Laparoendoscopic and Advanced Surgical Techniques, Vol. 26, No. 4, 01.04.2016, p. 299-301.

Research output: Contribution to journalArticle

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