Elsevier

Surgery

Volume 142, Issue 5, November 2007, Pages 761-768
Surgery

Position statement
Delayed gastric emptying (DGE) after pancreatic surgery: A suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)

https://doi.org/10.1016/j.surg.2007.05.005Get rights and content

Background

Delayed gastric emptying (DGE) is one of the most common complications after pancreatic resection. In the literature, the reported incidence of DGE after pancreatic surgery varies considerably between different surgical centers, primarily because an internationally accepted consensus definition of DGE is not available. Several surgical centers use a different definition of DGE. Hence, a valid comparison of different study reports and operative techniques is not possible.

Methods

After a literature review on DGE after pancreatic resection, the International Study Group of Pancreatic Surgery (ISGPS) developed an objective and generally applicable definition with grades of DGE based primarily on severity and clinical impact.

Results

DGE represents the inability to return to a standard diet by the end of the first postoperative week and includes prolonged nasogastric intubation of the patient. Three different grades (A, B, and C) were defined based on the impact on the clinical course and on postoperative management.

Conclusion

The proposed definition, which includes a clinical grading of DGE, should allow objective and accurate comparison of the results of future clinical trials and will facilitate the objective evaluation of novel interventions and surgical modalities in the field of pancreatic surgery.

Section snippets

Methods

An extensive, unlimited Medline search was performed to identify the existing literature on and definitions of DGE. The search strategy was set up by using a combination of text words combined with a medical subject headings database search. Reference lists of the retrieved literature were cross-searched manually for additional publications. All available major publications in the past 2 decades from high-volume surgical centers with an appropriate number of patients in the study were used as

Terminology

The terms used most commonly to identify the complication were delayed gastric emptying and gastroparesis. In the reviewed literature, DGE was classified regarding (1) the duration of nasogastric intubation and/or need for reinsertion of a nasogastric tube (NGT), and (2) the postoperative day (POD) when oral intake of solid food was tolerated after pancreatic resection.

Nasogastric tube

According to the standards of fast-track surgery and current postoperative management, the NGT should be removed as soon as

Discussion

The causes for DGE are still often unclear and are probably multifactorial.18, 25, 28, 70, 71, 72 Potential explanations for DGE after resective pancreatic surgery, especially pancreatoduodenectomy, include decreased plasma motilin concentrations caused by resection of the duodenum, extended lymph node dissection along the common hepatic artery with disruption of vagal and sympathetic innervation to the antropyloric regions, relative devascularization or denervation of the pylorus after

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