Diagnostic criteria and symptom grading for delayed gastric conduit emptying after esophagectomy for cancer: international expert consensus based on a modified Delphi process

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  • M Konradsson
    Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
  • M I van Berge Henegouwen
    Amsterdam UMC, location AMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam
  • C Bruns
    Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
  • M A Chaudry
    Department of Surgery, Royal Marsden Hospital, London, UK
  • E Cheong
    Norfolk and Norwich University Hospital, Norwich, UK
  • M A Cuesta
    Department of Surgery, Amsterdam UMC, location VUmc, Amsterdam, Netherlands
  • G E Darling
    Department of Surgery, Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Canada
  • S S Gisbertz
    Amsterdam UMC, location AMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam
  • S M Griffin
    Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  • C A Gutschow
    Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
  • R van Hillegersberg
    Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
  • W Hofstetter
    Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
  • A H Hölscher
    Centre for Esophageal and Gastric Surgery, AGAPLESION Markus Krankenhaus, Frankfurt, Germany
  • Y Kitagawa
    Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
  • J J B van Lanschot
    Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  • M Lindblad
    Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
  • L E Ferri
    Department of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, QC, Canada
  • D E Low
    Virginia Mason Medical Center, Seattle, WA, USA
  • M D P Luyer
    Department of Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
  • N Ndegwa
    Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
  • S Mercer
    Queen Alexandra Hospital Portsmouth, United Kingdom
  • K Moorthy
    The Center for Visceral, Thoracic and Specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Switzerland
  • C R Morse
    Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
  • P Nafteux
    Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
  • G A P Nieuwehuijzen
    Department of Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
  • P Pattyn
    Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
  • C Rosman
    Department of surgery, Radboud university center Nijmegen, The Netherlands
  • J P Ruurda
    Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
  • J Räsänen
    Department of General, Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
  • P M Schneider
    The Center for Visceral, Thoracic and Specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Switzerland
  • W Schröder
    Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
  • B Sgromo
    Oxford University Hospitals, Oxford, UK
  • H Van Veer
    Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
  • B P L Wijnhoven
    Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  • M Nilsson
    Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
  • Cancer
  • MS CGO
  • HUS Heart and Lung Center
  • III kirurgian klinikka
  • University of Helsinki
  • Helsinki University Hospital Area

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<jats:title>Abstract</jats:title> <jats:p>Delayed gastric conduit emptying (DGCE) after esophagectomy for cancer is associated with adverse outcomes and troubling symptoms. Widely accepted diagnostic criteria and a symptom grading tool for DGCE are missing. This hampers the interpretation and comparison of studies. A modified Delphi process, using repeated web-based questionnaires, combined with live interim group discussions was conducted by 33 experts within the field, from Europe, North America, and Asia. DGCE was divided into early DGCE if present within 14 days of surgery and late if present later than 14 days after surgery. The final criteria for early DGCE, accepted by 25 of 27 (93%) experts, were as follows: &gt;500 mL diurnal nasogastric tube output measured on the morning of postoperative day 5 or later or &gt;100% increased gastric tube width on frontal chest x-ray projection together with the presence of an air–fluid level. The final criteria for late DGCE accepted by 89% of the experts were as follows: the patient should have ‘quite a bit’ or ‘very much’ of at least two of the following symptoms; early satiety/fullness, vomiting, nausea, regurgitation or inability to meet caloric need by oral intake and delayed contrast passage on upper gastrointestinal water-soluble contrast radiogram or on timed barium swallow. A symptom grading tool for late DGCE was constructed grading each symptom as: ‘not at all’, ‘a little’, ‘quite a bit’, or ‘very much’, generating 0, 1, 2, or 3 points, respectively. For the five symptoms retained in the diagnostic criteria for late DGCE, the minimum score would be 0, and the maximum score would be 15. The final symptom grading tool for late DGCE was accepted by 27 of 31 (87%) experts. For the first time, diagnostic criteria for early and late DGCE and a symptom grading tool for late DGCE are available, based on an international expert consensus process.</jats:p>

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