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We describe the management of a large bronchoesophageal fistula secondary to Hodgkin lymphoma with a fully covered self-expanding metallic stent.

Objective: Gastric outlet obstruction is common after esophagectomy. Our goal was to determine the incidence of gastric outlet obstruction after esophagectomy with or withoutpyloromyotomy and analyzeits management by endoscopic pyloric dilatation.Methods:Two hundredfortytwo patientsunderwentesophagectomy with gastricconduit fromJanuary 2002to June 2006.Subjects were dividedintotwo groups:GroupA had no pyloromyotomy (n = 83) and Group B had a pyloromyotomy (n = 159). Gastric outlet obstruction was strictly defined to include patients with clinical delayed gastric emptying supported by symptoms, barium swallow studies, persistent air—fluid level and dilated conduit on radiography, or endoscopic or surgical intervention to improve gastric drainage. Results: The groups were similar except for a higher percentage of cervical anastomosis and olderage (64- vs 61-year-old) in Group A. The overallincidenceof gastric outlet obstruction was 15.3% (37/242). Pyloromyotomy did not reduce the incidence of gastric outlet obstruction (Group A 9.6% vs Group B 18.2%, p = 0.078). One patient required a late pyloroplasty. Successful management of gastric outlet obstruction with pyloric dilatation (96.7%, 28/29) was unaffected by pyloromyotomy. There was no difference in length of stay, pneumonia (Group A 27.7% vs Group B 19.5%, p = 0.15), respiratory failure or anastomotic stricture. There was no difference in anastomotic leaks when controlling for the anatomic location of the anastomosis (p = 0.36). Mortality was equivalent between groups (2.4 vs 2.5%, p = 0.96). Conclusion: Pyloromyotomy does not reduce the incidence of symptomatic delayed gastric emptying after esophagectomy. Post-operative gastricoutletobstructioncan beeffectivelymanagedwith endoscopicpyloricdilatation.Routine pyloromyotomy for the prevention of post-esophagectomy gastric outlet obstruction may be unwarranted. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Background Although early extubation of esophagectomy patients has been found to be feasible, safe, and associated with low morbidity, there is no uniform standard of care among high volume centers. Our objective is to examine a contemporary series of esophagectomies and identify the feasibility and outcome of an early extubation policy. Methods This study is a retrospective review of all patients who underwent esophagectomy between January 2003 and December 2004 at the Massachusetts General Hospital. One hundred and two patients were analyzed from 129 consecutive patients who underwent esophagectomy and subsequently divided in two groups: The early extubation group was extubated in the operating room and the late extubation group was extubated in the intensive care unit (ICU). Results Ninety percent were extubated early. Although most patients underwent a transthoracic or thoracoabdominal esophagectomy, the operative approach did not influence failure to extubate. Neoadjuvant therapy was not predictive of extubation failure. Most patients age 70 or greater (86%) were extubated early. There were three nonelective reintubations in the early extubation group secondary to acute respiratory distress syndrome. The median length of stay was 11 days and median ICU stay was one day. The 30-day mortality was 1.9% and the median survival was 28 months. Conclusions Attention to restricted intraoperative fluid balance, limited blood loss, anesthetic technique, and epidural use permit most patients undergoing esophageal resection to be safely extubated immediately postresection in the operating room.