Contemporary international practice patterns in the prevention, diagnosis, and management of delayed gastric conduit emptying after oesophagectomy: an international survey of oesophagogastric surgeons
Jonathan Sivakumar, Mohamed Abulazayem, Michael W Hii, Feras Alnimri, Alex Boddy, Yirupaiahgari K S Viswanath, Carlos Cabalag, David S Liu, Jessie A Elliott, Yogesh Vashist, Cuong P Duong,Summary
Delayed gastric conduit emptying (DGCE) is a common functional complication after oesophagectomy, yet it remains inconsistently defined and managed. Although consensus diagnostic criteria are available, their incorporation into routine audit and the contemporary international patterns of DGCE-related practice have not been characterized. This study aimed to describe current international practice in the prevention, diagnosis and management of DGCE. A cross-sectional online survey was developed and distributed to surgeons performing oesophagectomy internationally through The Upper Gastrointestinal Surgical Society. The 55-item instrument captured practice patterns and perceptions relating to DGCE across the perioperative care pathway and during follow-up. Associations were assessed using Pearson chi-square and Fisher’s exact tests. Two hundred and thirty surgeons from 57 countries responded. Fewer than one in five documented early (19.1%) or late (19.6%) DGCE using a standardized audit definition, and incidence was commonly perceived to be less than 10% for both. Prophylactic pyloric intervention was reported by 61.7% of respondents and varied significantly by operative platform, being more frequent among open and hybrid surgeons than minimally invasive or robotic surgeons (P = 0.013). Management of established DGCE was highly variable, with conservative and pharmacological measures predominating as first-line therapy and endoscopic pyloric interventions most commonly employed for refractory late DGCE. DGCE practice after oesophagectomy remains highly heterogeneous, shaped by institutional habit as much as by evidence. These findings support wider adoption of standardized DGCE definitions, incorporation of DGCE outcomes into institutional and national registries, and prospective trials comparing prophylactic pyloric strategies.