Central Surgical AssociationOptimal management of delayed gastric emptying after pancreatectomy: An analysis of 1,089 patients
Section snippets
Patient population and DGE definitions
The American College of Surgeons-National Surgical Quality Improvement Project is a validated, national program that collects prospectively patient characteristics, processes of care, and adverse outcomes to evaluate hospital performance with regard to surgical care.13 The American College of Surgeons-National Surgical Quality Improvement Project database at Indiana University Hospital was used to identify patients who underwent pancreatoduodenectomy or distal pancreatectomy between January
DGE
From 2007 to 2012, 708 patients underwent pancreatoduodenectomy and 381 underwent distal pancreatectomy. The overall incidence of DGE in 1,089 patients after pancreatectomy was 15% (n = 163). Patients who underwent pancreatoduodenectomy more likely to develop DGE (20%, n = 140/708) compared with those who underwent distal pancreatectomy (6% [n = 19/381]; P < .001). Of those with DGE, 45% (n = 73/163) were grades B or C and required supplemental nutrition, including 60% (n = 44/73) who received
Discussion
The incidence and clinical burden of DGE among patients undergoing pancreatectomy remains high. Much of the work published on DGE has focused on identifying risk factors associated with the development of DGE and its subsequent prevention. Most are small, single-institution series with substantial variability in the reported incidence and associated risk factors.4, 5, 6, 7, 8, 9, 10, 12 Despite the high incidence of DGE after pancreatectomy, evidence supporting its management is lacking, and
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Cited by (28)
Delayed gastric emptying following distal pancreatectomy: incidence and predisposing factors
2022, HPBCitation Excerpt :However, as suggested by the present study, two-thirds of DGE following DP are graded A, so it does not seem useful to routinely start enteral or parenteral nutrition. This point could represent a difference with DGE following PD in whom supplemental nutrition started before day 10 limits the risk of readmission.39 Since almost half of DGE following DP are secondary (42%) and POPF is found in 32% of patients with a DGE, a computed tomography scan to evaluate for abdominal collection, seems to be useful.
Previous upper abdominal surgery is a risk factor for nasogastric tube reinsertion after pancreaticoduodenectomy
2021, Surgery (United States)Predictors and outcomes of jejunostomy tube placement at the time of pancreatoduodenectomy
2019, Surgery (United States)Citation Excerpt :Although neither enteral nor parenteral nutritional support is superior to oral intake when tolerated, the benefits of enteral over parenteral nutrition in postoperative patients are well established.5,10,16,18,19,30 Concurrent CR-POPF and DGE is common, and many of these patients will require nutritional support.4,6,34,37,43,44 Early initiation of enteral tube feeds among patients with DGE has been associated with earlier resumption of oral diet and decreased 30-day readmission rates.44
The International Study Group of Pancreatic Surgery definition of delayed gastric emptying and the effects of various surgical modifications on the occurrence of delayed gastric emptying after pancreatoduodenectomy
2017, Hepatobiliary and Pancreatic Diseases InternationalChapter 27 - Postoperative complications requiring intervention: Diagnosis and management
2016, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas: Sixth EditionPostpancreatectomy Complications and Management
2016, Surgical Clinics of North AmericaCitation Excerpt :A recent retrospective study by the Indiana group compared outcomes between patients without DGE, those with DGE who received supplemental nutrition (EN and/or TPN) within 10 days after PD (early intervention), and those treated after 10 days (late intervention). The early intervention group resumed a regular diet sooner and were readmitted less than those in the late intervention group.47 Given the observed strong association between DGE and other complications, especially POPF, many investigators claimed that POPF preventing strategies may be the key to mitigate DGE.51