Applicability and results of the consensus definition of delayed gastric conduit emptying after esophagectomy

Abstract

Delayed gastric conduit emptying (DGCE) affects 15%–60% of patients after esophagectomy, depending on the definition used. This study evaluated DGCE incidence using the new consensus criteria and explored its clinical and scientific relevance. It also analyzed nasogastric tube (NGT) output to estimate a safe removal threshold. This retrospective single-center cohort study included patients who underwent elective Ivor Lewis esophagectomy (2020–2024). A total of 160 patients were included. The majority of patients underwent robot-assisted esophagectomy (n = 65 [40.6%]), whereas open esophagectomy was performed in 38 patients (23.7%). Early DGCE was identified in 40.6% of patients, predominantly via NGT output (95.4%), with few cases diagnosed radiologically (4.6%). DGCE was associated with longer hospital stays (24 vs. 18 days, p = 0.034) and higher NGT reinsertion rates (47.0% vs. 28.7%, p = 0.02), but not with differences in surgical approach or major complications (Clavien–Dindo Classification > IIIa: 18.2% vs. 13.8%, p = 0.72). Late DGCE was diagnosed in only 8 patients (5.0%), mainly because of the low use of routine radiological imaging. In the cohort of patients who did not require NGT reinsertion, the median of the average nasogastric tube output for the 2 days before removal was 200 mL per day. The consensus definition of DGCE is applicable and identifies a clinically relevant incidence of over 40%. An average daily NGT output of 200 mL appears to reliably predict safe tube removal.