Delayed gastric emptying after esophagectomy: a single centre experience—comparison of the international expert consensus definition to the local definition

Background: Delayed gastric emptying (DGE) affects up to 37% of patients after esophagectomy. An international expert consensus (IEC) agreed on a diagnostic criterion in 2020. The degree of adoption of this definition worldwide and how it compares to well established definitions locally with subtle, yet significant differences is unknown. The aim of this observational study was to compare the IEC definition of DGE to the definition at the University Hospital Plymouth (UHP) esophago-gastric surgery unit. Methods: Consecutive patients who underwent esophagectomy for cancer at UHP between April 2019 and August 2020 were analysed. The IEC definition was applied retrospectively and the rates of DGE were compared between the two criteria. Results: One hundred patients [74 male (74%), median age 60 (range, 45–84 years)] were analysed. The rates of early DGE according to the UHP and IEC definitions were 27% and 20% respectively (P=0.24). Twenty-nine patients (29%) underwent pyloric dilatation (17 patients within 14 days post operatively). The sensitivity and specificity of the UHP vs. IEC definition of early DGE in identifying those who required pyloric dilation were 86.2% and 97.2% vs. 37.9% and 87.3% respectively. Out of the 12 patients who underwent late dilatations (>14 days post op), the UHP and IEC early DGE definition predicted 75% (n=8) and 17% (n=2) respectively (P=0.52). Conclusions: The sensitivity and specificity of the IEC criteria at identifying patients with early DGE is lower than the UHP criteria which also appeared to predict patients with late DGE.