{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T16:47:32Z","timestamp":1775666852098,"version":"3.50.1"},"reference-count":38,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: As multimodal therapy for esophageal cancer advances, addressing immediate and long-term functional outcomes following surgery has become more important. Despite surgical advancements, delayed gastric conduit emptying (DGCE) remains a primary cause of functional impairment after esophageal cancer resection. The literature addressing pylorus management following minimally invasive esophagectomy (MIE) is scarce. The effects of pyloric drainage with pyloromyotomy or postoperative approaches such as intrapyloric Botox injection or dilatation on the incidence and course of DGCE were the focus of this study. Methods: A retrospective analysis of consecutive patients after minimally invasive esophagectomy with thoracic esophagogastric anastomosis and gastric tube reconstruction between 2014 and 2023 was performed. Univariate analyses were used to identify significant patient-, tumor-, and procedure-related factors affecting DGCE. Results: A total of 276 patients were included. DGCE was observed in 80 (28.9%) patients. Demographics did not differ with statistical significance. Postoperative complications were not increased in patients with DGCE. Pyloric intervention (PI) did not reduce postoperative occurrence of DGCE (PI: n = 19\/23.75% compared to no PI: n = 62 (30.5%), p = 0.342). Median length of hospital stay was significantly longer, and total costs were significantly higher in patients with DGCE (p = 0.03 and p = 0.047, respectively). Analysis of endoscopic approaches was not associated with a statistically significant difference between botulinum toxin injection and pyloric dilatation with regard to reinterventions. Conclusions: While DGCE is frequent after esophagectomy, it is not associated with short-term morbidity but with prolonged total hospital stay and increased costs. Intraoperative pyloric intervention does not influence the incidence of DGCE after esophagectomy and endoscopic management was associated with therapeutic success, but choice of specific, optimal approach remains elusive. Novel concepts, including preoperative dilatation should be investigated.<\/jats:p>","DOI":"10.3390\/jcm15082829","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T15:26:39Z","timestamp":1775661999000},"page":"2829","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Endoscopic and Intraoperative Approaches in the Management of Delayed Gastric Conduit Emptying After Minimally Invasive Esophagectomy: A Single-Center Retrospective Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8294-3560","authenticated-orcid":false,"given":"Ramin Raul","family":"Ossami Saidy","sequence":"first","affiliation":[{"name":"Chirurgische Klinik, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippa","family":"Seika","sequence":"additional","affiliation":[{"name":"Chirurgische Klinik, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Berlin Institute of Health, Charit\u00e9 Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max M.","family":"Maurer","sequence":"additional","affiliation":[{"name":"Chirurgische Klinik, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Berlin Institute of Health, Charit\u00e9 Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4610-1766","authenticated-orcid":false,"given":"Paul Viktor","family":"Ritschl","sequence":"additional","affiliation":[{"name":"Chirurgische Klinik, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3690-8614","authenticated-orcid":false,"given":"Matthias","family":"Biebl","sequence":"additional","affiliation":[{"name":"Abteilung f\u00fcr Chirurgie, Ordensklinikum Linz, 4010 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dino","family":"Kr\u00f6ll","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery and Medicine, Inselspital Bern, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johann","family":"Pratschke","sequence":"additional","affiliation":[{"name":"Chirurgische Klinik, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Denecke","sequence":"additional","affiliation":[{"name":"Chirurgische Klinik, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"ref_1","first-page":"106","article-title":"Minimally invasive versus open esophagectomy for resectable thoracic esophageal cancer (NST 1502): A multicenter prospective cohort study","volume":"3","author":"Mao","year":"2023","journal-title":"J. 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