Endoscopic gastric conduit plication: a novel endoscopic technique for delayed gastric conduit emptying following oesophagectomy

Gastric conduit is the preferred reconstruction following oesophagectomy. Patients can develop delayed gastric conduit emptying because of dilatation and poor drainage. We present a novel technique utilising endoscopic suturing to plicate the gastric conduit, improving drainage, reducing sumping and improving quality of life. An 81-year-old man who underwent an oesophagectomy for pT1bN0M0 oesophageal adenocarcinoma presented 6 years later with nutritional failure, body mass index (BMI) 17.5 and recurrent aspiration pneumonia. The gastric conduit had dilated, resulting in significant redundancy and sumping. Endoscopic suture plication of the conduit was performed to avoid the risks of surgical revision. Expertise developed in the practice of endoscopic sleeve gastroplasty was utilised to perform intrathoracic gastric conduit plication, eliminating sumping and reducing conduit redundancy. Following endoscopic gastric conduit plication, contrast swallow demonstrated improved shape and drainage of the conduit. At 6- and 12-month follow-up the patient reported improved diet tolerance, an increased BMI of 24.7 and there had been no hospitalisations for aspiration. EORTC QLQ OG25 scores improved from 60 to 32. Our novel technique for plication of an intrathoracic gastric conduit represents a useful strategy to increase the longevity and function of gastric conduits in oesophageal cancer survivors and those undergoing benign resections where long-term high-quality function of the conduit is important for optimal patient outcomes.