PD02.04. Persistent Gastric Conduit Electrophysiological Abnormalities After Esophagectomy Assessed by High-Resolution Body Surface Mapping

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes Delayed gastric conduit emptying and functional morbidity remain common after esophagectomy, yet the underlying physiologic mechanisms are incompletely defined. This study characterized gastric conduit electrophysiology using high-resolution body surface gastric mapping and examined associations with symptoms, delayed gastric conduit emptying (DGCE), and clinical outcomes. Thirty adults ≥12 months following Ivor Lewis esophagectomy were prospectively enrolled and compared with 30 matched controls. Participants underwent fasting and 4-hour postprandial high-resolution body surface gastric mapping using a 64-channel array. Spectral metrics included principal gastric frequency, BMI-adjusted amplitude, and Gastric Alimetry Rhythm Index (GA-RI). Patient-reported outcomes were assessed using PAGI-SYM, PAGI-QoL, total symptom burden score (TSBS), and Konradsson’s DGCE grading tool. Electrophysiologic phenotypes were classified according to validated criteria. Between-group comparisons used paired statistical testing. Associations between electrophysiologic parameters, symptom burden, and DGCE were assessed using Pearson correlation and ANOVA with correlation ratio (η). Statistical significance was defined as p<0.05. Post-esophagectomy patients demonstrated significantly reduced principal gastric frequency (2.65±0.37 vs 3.11±0.24 cpm; p<0.0001) and BMI-adjusted amplitude (27.1±11.1 vs 40.5±17.3 μV; p=0.0007) compared with controls. GA-RI did not differ significantly. Twenty-three patients (76.7%) exhibited abnormal electrophysiologic phenotypes, predominantly low-frequency activity. Symptom burden was significantly greater in patients, with worse PAGI-SYM, PAGI-QoL, and TSBS scores (all p<0.01). DGCE was present in 7 patients (23.3%) and correlated strongly with symptom severity (PAGI-SYM r=0.72) and quality-of-life impairment (r=–0.54). Principal gastric frequency correlated with nausea (r=0.49), while BMI-adjusted amplitude correlated with excessive fullness (r=0.49) and upper gastrointestinal pain (r=0.48). The gastric conduit exhibits reproducible and clinically relevant electrophysiologic abnormalities years after esophagectomy. These objective phenotypes correlate with symptom burden and offer mechanistic insight beyond conventional clinical assessment. High-resolution body surface gastric mapping represents a novel and scalable platform for physiologic stratification, with potential to guide personalized, mechanism-based management in post-esophagectomy patients.