Measuring and quantifying the effects of pyloric dilatation in patients with delayed emptying of the gastric conduit after Ivor-Lewis esophagectomy using EndoFlip™

The most common functional challenge after Ivor-Lewis esophagectomy is delayed emptying of the gastric conduit. One of the primary endoscopic treatment strategies is performing a pyloric dilatation. However, the effects of dilation have never been scientifically proven. A novel method to detect pyloric distensibility (DI) is the endoluminal functional lumen imaging probe (EndoFlip™). The purpose of this study is to analyze the effects of pyloric dilatation using an EndoFlip™ measurement. Forty-nine patients after Ivor-Lewis esophagectomy were included retrospectively from June 2021 to August 2023 at University Hospital Cologne, Germany. All patients suffered from early delayed emptying of the gastric conduit (DGCE). DI was measured before and after endoscopic dilatation using EndoFlip™ at 40, 45, and 50 mL balloon filling. The Student's t-test and Chi-Squared test were used. All tests were two-sided, with statistical significance set at P ≤ 0.05. EndoFlip™ measurement and pyloric dilatation were feasible in all patients and no adverse events were recorded. DI proved to be smaller in patients before dilatation compared to patients after dilatation. For 40, 45, and 50 mL balloon filling, the mean DI was 5.0 versus 10.0, 4.5 versus 9.1, and 4.0 and 7.5 mm2/mmHg before versus after dilatation. The differences were significant in all balloon fillings. Endoscopic dilatation of the pylorus is the primary endoscopic treatment strategy in patients suffering from DGCE. Currently, the success of dilatation can only be measured with clinical data. This study could demonstrate that EndoFlip™ can be used as an additional diagnostic tool to rate the success of pyloric dilatation.