Endoscopic balloon dilation of the pylorus after esophagogastrostomy without a drainage procedure.

The necessity to perform a drainage procedure after esophagectomy using the stomach for substitution remains controversial. Transection of the pyloric sphincter may cause severe and debilitating gastroesophagitis because of increased duodenogastric reflux. Omitting the drainage procedure may lead to gastric stasis. In the patient group we studied (n = 50), 42 had partial esophagogastrectomy and intrathoracic esophagogastrostomy, 12 with and 30 without a drainage procedure. Eight had total thoracic esophagectomy and cervical esophagastrostomy using the entire stomach without a drainage procedure. Gastric stasis was not observed in the 12 patients with a drainage procedure, but in six, duodenal reflux gastroesophagitis caused considerable morbidity. This complication was seen only once in the group (n = 38) who did not have a drainage procedure. Four of the 38 patients with an intact pylorus (one patient after partial esophagogastrectomy and three patients after total thoracic esophagectomy) showed persistent pyloric closure. However, this complication was successfully managed by endoscopic balloon dilation under fluoroscopic survey. The results suggest that, after esophagectomy, the integrity of the pyloric sphincter should be preserved, since the complication arising from this policy can be simply managed by endoscopic balloon dilation.