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Background <p>Gastric ischemic conditioning (GIC) before esophagectomy has been proposed to enhance the vascular submucosal network of the gastric conduit and perfusion at the anastomotic site. Its advantages remain controversial due to inconsistent literature findings, often attributed to heterogeneity in patient selection, targeted vessels, timing, and variations in GIC technique. We conducted a survey to assess contemporary surgical practices regarding GIC utilization prior to esophagectomy among expert foregut surgeons.</p> Methods <p>A Google-based survey was conducted in accordance with the CHERRIES checklist, developed following an extensive literature review and directed towards expert foregut surgeons. The survey comprised 39 questions covering demographic data, professional experience, surgical modalities for esophagectomy, indications, timing, and technical aspects for GIC.</p> Results <p>Overall, 115 expert foregut surgeons participated in the survey (response rate 76.7%). Overall, 56.4% indicated that they do not perform GIC whereas 43.6% reported utilizing GIC before esophagectomy. Main reasons for not performing GIC included lack of supporting literature (57.1%) and no clear benefit in reducing AL rate (42.9%). Selective GIC use was most often based on celiac trunk stenosis or calcification (67.7%), history of coronary stenting/bypass (48.4%), and thoracic aorta calcification (41.9%). Overall, 59.6% of experts using GIC preferred laparoscopy while 40.4% favored embolization. Laparoscopy was preferred for cancer staging, jejunostomy formation, and hospital availability; embolization was preferred for its simplicity, avoidance of general anesthesia, absence of adhesions, and ability to dynamically assess the vascular anatomy intraprocedural. The left gastric artery was the most frequently targeted vessel (&gt; 90%) for both laparoscopy and embolization, either individually or in combination with the short gastric vessels or the left gastroepiploic artery. Almost 70% of GIC users indicated a preference for performing GIC ≥ 14&#xa0;days before esophagectomy.</p> Conclusions <p>The survey indicates that less than half of the experts support GIC prior to esophagectomy, preferring its selective application. Laparoscopy is preferred over embolization, likely due to better tumor staging and greater hospital availability. Most respondents also prefer GIC to be performed more than 14&#xa0;days before esophagectomy.</p>

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Gastric ischemic conditioning before esophagectomy: contemporary practices and insights from an international survey

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  • 发表日期：

    2026年3月16日

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  • Alberto Aiolfi,
  • Davide Bona,
  • Andrea Sozzi,
  • Yves Borbély,
  • Luigi Bonavina,
  • Ahmed Abdelsamad,
  • Alan Patrick Ainsworth,
  • Jacopo Andreuccetti,
  • Filippo Ascari,
  • Karim Ataya,
  • Gian Luca Baiocchi,
  • Andrea Balla,
  • Hasan Batirel,
  • Maria Bencivenga,
  • Adrian Billeter,
  • Antonio Biondi,
  • Damien Bouriez,
  • Giuseppe Brisinda,
  • Andrea Celotti,
  • Giovanni Cestaro,
  • Yin-Kai Chao,
  • Edward Cheong,
  • Mircea Chirica,
  • Prokopis Christodoulou,
  • Luca Cigagna,
  • Davide Citterio,
  • Xavier Benoit D‘Journo,
  • Andrew Davies,
  • Roberto De Anton,
  • Andrew De Beaux,
  • Pieter De Heer,
  • Dionysios Dellaportas,
  • Lieven Depypere,
  • Jessie Elliott,
  • Moustafa Elshafei,
  • Alessia Fassari,
  • Agostino Fernicola,
  • Lorenzo Ferri,
  • Uberto Fumagalli Romario,
  • Giovanni Maria Garbarino,
  • Suzanne Gisbertz,
  • Ioannis Gkoutziotis,
  • Ines Gockel,
  • Antonietta Gerarda Gravina,
  • Tristan Greilsamer,
  • Ewen Griffiths,
  • Caroline Gronnier,
  • Christian Gutschow,
  • Osman Serhat Güner,
  • Nader Hanna,
  • Jakob Hedberg,
  • Nienhüser Henrik,
  • Petre Hoara,
  • Arnulf Hölscher,
  • Nidal Iflazoğlu,
  • Takeharu Imai,
  • Orestis Ioannidis,
  • Jan Johansson,
  • Aristotelis Kechagias,
  • Ebrahimi Keramatollah,
  • Fredrik Klevebro,
  • Efstathioa Kotidis,
  • Paul Leeder,
  • Xuefeng Leng,
  • John Lipham,
  • Donald Low,
  • Sheraz Markar,
  • Javier Martínez Caballero,
  • Kristel Mils,
  • Fernando Mingol Navarro,
  • Luyer Misha,
  • Daniela Molena,
  • Stefan Mönig,
  • Philippe Nafteux,
  • Grard Nieuwenhuijzen,
  • Magnus Nilsson,
  • Fabio Massimo Oddi,
  • Akihiko Okamura,
  • Felipe Carlos Parreño-Manchado,
  • Raffaele Pellegrino,
  • Kyle Perry,
  • Alexander Phillips,
  • Gaetano Piccolo,
  • Guillaume Piessen,
  • Calin Popa,
  • Dario Potkonjak,
  • Daniel Reim,
  • Elisa Reitano,
  • Riccardo Rosati,
  • Ioannis Rouvelas,
  • Carlo Alberto Schena,
  • Lars Schiffmann,
  • Dimitrios Schizas,
  • Francisco Schlottmann,
  • Thomas Schmidt,
  • Marcel Schneider,
  • Sebastian Schoppmann,
  • Rivfka Shenoy,
  • Wolfgang Schroeder,
  • Aleksandar Simic,
  • Ognjan Skrobic,
  • Vladimir Sljukic,
  • Jennifer Straatman,
  • Dimitrios Theodorou,
  • Tania Triantafyllou,
  • Mehmet Akif Üstüner,
  • Mustafa Yener Uzunoglu,
  • Gijs Van Boxel,
  • Elke Van Daele,
  • Hanne Vanommeslaeghe,
  • Dejan Velickovic,
  • Neil Welch,
  • Omer Yalkin,
  • Jörg Zehetner,
  • Maurizio Zizzo

摘要

Background

Gastric ischemic conditioning (GIC) before esophagectomy has been proposed to enhance the vascular submucosal network of the gastric conduit and perfusion at the anastomotic site. Its advantages remain controversial due to inconsistent literature findings, often attributed to heterogeneity in patient selection, targeted vessels, timing, and variations in GIC technique. We conducted a survey to assess contemporary surgical practices regarding GIC utilization prior to esophagectomy among expert foregut surgeons.

Methods

A Google-based survey was conducted in accordance with the CHERRIES checklist, developed following an extensive literature review and directed towards expert foregut surgeons. The survey comprised 39 questions covering demographic data, professional experience, surgical modalities for esophagectomy, indications, timing, and technical aspects for GIC.

Results

Overall, 115 expert foregut surgeons participated in the survey (response rate 76.7%). Overall, 56.4% indicated that they do not perform GIC whereas 43.6% reported utilizing GIC before esophagectomy. Main reasons for not performing GIC included lack of supporting literature (57.1%) and no clear benefit in reducing AL rate (42.9%). Selective GIC use was most often based on celiac trunk stenosis or calcification (67.7%), history of coronary stenting/bypass (48.4%), and thoracic aorta calcification (41.9%). Overall, 59.6% of experts using GIC preferred laparoscopy while 40.4% favored embolization. Laparoscopy was preferred for cancer staging, jejunostomy formation, and hospital availability; embolization was preferred for its simplicity, avoidance of general anesthesia, absence of adhesions, and ability to dynamically assess the vascular anatomy intraprocedural. The left gastric artery was the most frequently targeted vessel (> 90%) for both laparoscopy and embolization, either individually or in combination with the short gastric vessels or the left gastroepiploic artery. Almost 70% of GIC users indicated a preference for performing GIC ≥ 14 days before esophagectomy.

Conclusions

The survey indicates that less than half of the experts support GIC prior to esophagectomy, preferring its selective application. Laparoscopy is preferred over embolization, likely due to better tumor staging and greater hospital availability. Most respondents also prefer GIC to be performed more than 14 days before esophagectomy.