Position statementDelayed gastric emptying (DGE) after pancreatic surgery: A suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)
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
References (73)
- et al.
A systematic review of surgical therapy for gastroparesis
Am J Gastroenterol
(2003) - et al.
Erythromycin stimulates gastric emptying after esophagectomy with gastric replacement: a randomized clinical trial
J Thorac Cardiovasc Surg
(1996) - et al.
Delayed gastric emptying after gastric surgery
Am J Surg
(1996) - et al.
Differences in gastric emptying between highly selective vagotomy and posterior truncal vagotomy combined with anterior seromyotomy
J Gastrointest Surg
(1999) - et al.
Intrathoracic gastric emptying of solid food after esophagectomy for esophageal cancer
Ann Thorac Surg
(2005) - et al.
Postoperative pancreatic fistula: an international study group (ISGPF) definition
Surgery
(2005) - et al.
Postpancreatectomy hemorrhage (PPH)—an International Study Group of Pancreatic Surgery definition (ISGPS)
Surgery
(2007) - et al.
Enteral nutrition prolongs delayed gastric emptying in patients after Whipple resection
Am J Surg
(2000) - et al.
Role of the duodenum in the control of canine gastrointestinal motility
Gastroenterology
(1988) - et al.
Pancreatic head resection with and without preservation of the duodenum: different postoperative gastric motility
Surgery
(1996)
Gastric emptying following pylorus-preserving Whipple and duodenum-preserving pancreatic head resection in patients with chronic pancreatitis
Am J Surg
Outcome after duodenum-preserving pancreatic head resection is improved compared with classic Whipple procedure in the treatment of chronic pancreatitis
Surgery
Randomized prospective trial of pylorus-preserving vs. classic duodenopancreatectomy (Whipple procedure): initial clinical results
J Gastrointest Surg
Factors influencing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy
J Am Coll Surg
Method of pyloric reconstruction and impact upon delayed gastric emptying and hospital stay after pylorus-preserving pancreaticoduodenectomy
J Gastrointest Surg
Delayed gastric emptying after pylorus-preserving pancreatoduodenectomy is strongly related to other postoperative complications
J Gastrointest Surg
Postoperative acute pancreatitis as a major determinant of postoperative delayed gastric emptying after pancreaticoduodenectomy
J Gastrointest Surg
A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy
Am J Surg
Delayed hemorrhage after pancreaticoduodenectomy
J Am Coll Surg
Ischemic gastroparesis: resolution after revascularization
Gastroenterology
The diagnosis and work-up of the patient with gastroparesis
J Clin Gastroenterol
Current perspectives on the management of gastroparesis
J Postgrad Med
An analysis of the possible factors contributing to the delayed return of gastric emptying after gastrojejunostomy
Surg Today
Delayed postoperative emptying after esophageal resection is dependent on the size of the gastric substitute
J Am Coll Surg
Gastroparesis after a pylorus-preserving pancreatoduodenectomy
Surg Today
Advances in mechanisms of postsurgical gastroparesis syndrome and its diagnosis and treatment
Chin J Dig Dis
Delayed massive haemorrhage after pancreatic and biliary surgery
Br J Surg
The complications of pancreatectomy
Ann Surg
Management of complications after pancreaticoduodenectomy in a high volume centre: results on 150 consecutive patients
Dig Surg
Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma
Br J Surg
Complications following pancreaticoduodenectomyCurrent management
Arch Surg
Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes
Ann Surg
Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy
Arch Surg
Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery?
Ann Surg
Haemorrhage following pancreaticoduodenectomy: risk factors and the importance of sentinel bleed
Dig Surg
Extended drainage versus resection in surgery for chronic pancreatitis: a prospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus-preserving pancreatoduodenectomy
Ann Surg
Cited by (2247)
Cross-sectional imaging after pancreatic surgery: The dialogue between the radiologist and the surgeon
2024, European Journal of Radiology OpenShort- and long-term outcomes after distal pancreatectomy with radiologic infiltration of splenic vessels for pancreatic ductal adenocarcinoma
2024, Journal of Gastrointestinal Surgery