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

Background: Delayed gastric conduit emptying (DGCE) is observed in 15%–60% of patients after esophagectomy, depending on the definition used. The diagnosis of DGCE has been challenging due to the absence of standardized criteria. However, in 2020, an expert consensus was published.

Aims: This study aimed to determine the DGCE rate according to the new consensus definition and evaluate its clinical and scientific applicability. Additionally, nasogastric tube (NGT) output volumes were analyzed to approximate a threshold for safe removal.

Methods: This retrospective study included all patients who underwent elective esophagectomy at the Department of General, Visceral and Thoracic Surgery, Universitätsklinikum Eppendorf, Hamburg, Germany, using the Ivor Lewis or McKeown procedure for oncological or non-oncological esophageal diseases between 2020 and 2024.

Results: A total of 160 patients were included. The majority underwent robot-assisted esophagectomy (n=65 [40.6%]), whereas open approach was performed in 38 cases (23,7%). Early DGCE occurred in 65 patients (40.6%), with 95.4% diagnosed based on NGT output and 4.6% based on radiological imaging. DGCE patients had a significantly longer hospital stay (24 days [IQR 16–38] vs. 18 days [IQR 15–36], p=0.034) and a higher NGT reinsertion rate (47.0% vs. 28.7%, p=0.02). DGCE was observed across all surgical approaches without a significant difference. No significant difference was found in the number or severity of postoperative complications, including anastomotic leakage (CDC>IIIa: 18.2% vs. 13.8%, p=0.72). Late DGCE was diagnosed in only 8 patients (5%), mainly due to the low use of routine radiological imaging. Patients requiring NGT reinsertion had a significantly higher complication rate, with anastomotic leakage observed in 60.3% compared to 8.8% in patients without reinsertion (p<0.001). The median NGT volume in the two days prior to removal was significantly higher in DGCE patients: 300 ml (IQR 188–525) vs. 100 ml (IQR 0–229) in non-DGCE patients (p<0.001).

Conclusion: The consensus definition of DGCE is applicable. Early DGCE is a relevant complication in>40% after esophagectomy irrespective of the surgical approach. An average NGT output of<300 ml during the two days before removal is associated with a low rate of DGCE and may serve as a threshold for NGT removal.

Publication History

Article published online:
04 September 2025