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Preoperative and postoperative complications as risk factors for delayed gastric emptying following pancreaticoduodenectomy: A single-center retrospective study

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世界胃肠外科杂志:英文版(电子版) 2023年第9期15卷 1941-1949页

作者： Fang-Liang Xie Li-Jun Ren Wei-Dong Xu Tong-Lei Xu Xia-Qing Ge Wei Li Xu-Ming Ge Wen-Kai Zhou Kai Li Yun-Hai Zhang Zhong Wang Department of Hepatobiliary Surgery Xuzhou Medical University Affiliated Hospital of Lianyungang(The First People's Hospital of Lianyungang)Lianyungang 222061Jiangsu ProvinceChina Operating Theatre Xuzhou Medical University Affiliated Hospital of Lianyungang(The First People's Hospital of Lianyungang)Lianyungang 222061Jiangsu ProvinceChina Department of Pain Xuzhou Medical University Affiliated Hospital of Lianyungang(The First People's Hospital of Lianyungang)Lianyungang 222061Jiangsu ProvinceChina

BACKGROUND Mortality rates after pancreaticoduodenectomy(PD)have significantly decreased in specialized centers.However,postoperative morbidity,particularly delayed gastric emptying(DGE),remains the most frequent complication following PD.AIM To identify risk factors associated with DGE after the PD procedure.METHODS In this retrospective,cross-sectional study,clinical data were collected from 114 patients who underwent PD between January 2015 and June 2018.Demographic factors,pre-and perioperative characteristics,and surgical complications were assessed.Univariate and multivariate analyses were performed to identify risk factors for post-PD DGE.RESULTS The study included 66 males(57.9%)and 48 females(42.1%),aged 33-83 years(mean:62.5),with a male-to-female ratio of approximately 1.4:1.There were 63 cases(55.3%)of PD and 51 cases(44.7%)of pylorus-preserving pancreatoduodenectomy.Among the 114 patients who underwent PD,33(28.9%)developed postoperative DGE.Univariate analysis revealed significant differences in four of the 14 clinical indexes observed:pylorus preservation,retrocolonic anastomosis,postoperative abdominal complications,and early postoperative albumin(ALB).Logistic regression analysis further identified postoperative abdominal complic-ations[odds ratio(OR)=4.768,P=0.002],preoperative systemic diseases(OR=2.516,P=0.049),and early postoperative ALB(OR=1.195,P=0.003)as significant risk factors.CONCLUSION Postoperative severe abdominal complications,preoperative systemic diseases,and early postoperative ALB are identified as risk factors for post-PD DGE.

关键词： delayed gastric emptying Postoperation Pancreaticoduodenectomy Treatment

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Perioperative risk factors for delayed gastric emptying after pancreaticoduodenectomy:a meta-analysis of the complications

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Journal of Pancreatology 2023年第2期6卷 67-73页

作者： Xiaowei Deng Ting Niu Zhaolong Han Xing Liang Zhiping Fu Liang Tang Guang Yang Judong Li An’an Liu Junfeng Peng Minghui Zheng Chenghao Shao Department of Pancreatic-biliary Surgery Changzheng HospitalNaval Medical UniversityShanghai 200003

Objective:To evaluate the correlation between the incidence of delayed gastric emptying(DGE)in pancreaticoduodenectomy(PD)and the perioperative possible risk factors.Methods:We searched PubMed,Embase,Cochrane Library,and Medline for studies describing complications related to PD from 2018 to 2022.Statistical analysis was performed using Stata/SE16.0 software.Results:In 6 retrospective studies,1 systematic review,and 1 randomized controlled trial(RCT)experiment,12,419 patients(2174 and 10,245 patients,respectively,in DGE and no delayed gastric emptying[NDGE]groups).The preoperative American Society of Anesthesiologists(ASA)score between DGE and NDGE groups(log odds ratio[OR]=0.23,95%credible interval[CI]:0.11-0.35,P.05).Conclusion:The incidence of DGE is significantly correlated with the operation time,preoperative ASA score,POPF,and EIBL,which suggests that the surgeon should thoroughly evaluate the patient through adequate preoperative examination before the operation.Finally,standardized practice and perfect technology are undoubtedly necessary to reduce complications.

关键词： Complications delayed gastric emptying Pancreaticoduodenectomy Perioperative period Risk factors

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Complete resection of the gastric antrum decreased incidence and severity of delayed gastric emptying after pancreaticoduodenectomy

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Hepatobiliary & Pancreatic Diseases International 2021年第2期20卷 182-189页

作者： Yu-Ling Sun Jian-Jun Gou Kai-Ming Zhang Wen-Qi Li Xiu-Xian Ma Lin Zhou Rong-Tao Zhu Jian Li Institute of Hepatobiliary and Pancreatic Diseases Department of Hepatobiliary and Pancreatic Surgerythe First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China Department of Digestive the First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China

Background:delayed gastric emptying(DGE)is the main complication after pancreaticoduodenectomy(PD),but the mechanism is still unclear.The aim of this study was to elucidate the role of complete resection of the gastric antrum in decreasing incidence and severity of DGE after PD.Methods:Sprague-Dawley rats were divided into three groups:expanded resection(ER group),complete resection(CR group),and incomplete resection(IR group)of the gastric antrum.The tension(g)of remnant stomach contraction was observed.We analyzed the histological morphology of the gastric wall by different excisional methods after distal gastrectomy.Moreover,patients underwent PD at our department between January 2012 and May 2016 were included in the study.These cases were divided into IR group and CR group of the gastric antrum,and the clinical data were retrospectively analyzed.Results:The ex vivo remnant stomachs of CR group exhibited much greater contraction tension than others(Pgastric wall confirmed that the number of transected circular smooth muscle bundles were higher in IR group than in CR group(8.24±0.65 vs.3.76±0.70,Pgastric antrum is associated with decreased incidence and severity of DGE after PD.gastric electrophysiological and physiopathological disorders caused by damage to gastric smooth muscles might be the mechanism underlying DGE.

关键词： delayed gastric emptying gastric antrum gastric electrophysiology Histological morphology Pancreaticoduodenectomy

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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

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Hepatobiliary & Pancreatic Diseases International 2017年第4期16卷 353-363页

作者： Rajesh Panwar Sujoy Pal Department of Gastrointestinal Surgery & Liver Transplantation All India Institute of Medical SciencesNew DelhiIndia

BACKGROUND:A number of definitions have been used for delayed gastric emptying(DGE) after pancreatoduodenectomy and the reported rates varied widely.The International Study Group of Pancreatic Surgery(ISGPS) definition is the current standard but it is not used universally.In this comprehensive review,we aimed to determine the acceptance rate of ISGPS definition of DGE,the incidence of DGE after pancreatoduodenectomy and the effect of various technical modifications on its incidence.DATA SOURCE:We searched PubM ed for studies regarding DGE after pancreatoduodenectomy that were published from 1 January 1980 to 1 July 2015 and extracted data on DGE definition,DGE rates and comparison of DGE rates among different technical modifications from all of the relevant articles.RESULTS:Out of 435 search results,178 were selected for data extraction.The ISGPS definition was used in 80% of the studies published since 2010 and the average rates of DGE and clinically relevant DGE were 27.7%(range:0-100%;median:18.7%) and 14.3%(range:1.8%-58.2%;median:13.6%),respectively.Pylorus preservation or retrocolic reconstruction were not associated with increased DGE rates.Although pyloric dilatation,Braun’s entero-enterostomy and Billroth Ⅱ reconstruction were associated with significantly lower DGE rates,pyloric ring resection appears to be most promising with favorable results in 7 out of 10 studies.CONCLUSIONS:ISGPS definition of DGE has been used in majority of studies published after 2010.Clinically relevant DGE rates remain high at 14.3% despite a number of proposed surgical modifications.Pyloric ring resection seems to offer the most promising solution to reduce the occurrence of DGE.

关键词： pancreatoduodenectomy delayed gastric emptying ISGPS definition pyloric ring resection

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Risk factors for postoperative delayed gastric emptying in ovarian cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

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World Journal of Clinical Cases 2021年第18期9卷 4644-4653页

作者： Guang-Xia Cui Zi-Jun Wang Jin Zhao Ping Gong Shuai-Hong Zhao Xiao-Xue Wang Wen-Pei Bai Yan Li Department of Gynecology Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China Department of Peritoneal Caner Surgery Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China

BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy(CRSHIPEC)has shown promising results in improving the survival of ovarian cancer patients.Although the safety profiles of CRS-HIPEC exist,more attention should be paid to gastrointestinal complications,as the procedure involves a considerable proportion of bowel resection and anastomosis.AIM To identify the risk factors for delayed gastric emptying in ovarian cancer treated with CRS-HIPEC.METHODS A cross-sectional study was conducted.According to the inclusion and exclusion criteria,we retrospectively analyzed 77 patients admitted between March 2014 and April 2018 with advanced and recurrent ovarian cancer treated with CRSHIPEC in Beijing Shijitan Hospital of Capital Medical University.Risk factors for delayed gastric emptying were analyzed using univariate analysis.All of the statistically significant variables in the univariate analysis were entered into the multivariable logistic regression model to determine factors independently associated with delayed gastric emptying.RESULTS Among the 77 included patients,36.4%(28/77)had delayed gastric emptying after CRS-HIPEC.The median age and body mass index of all patients were 59 years and 22.83 kg/m^(2),respectively.Preoperative chemotherapy was administered in 55 patients(71%).Sixty-two patients(81%)had a history of at least one previous pelvic surgery.The median operation time and intraoperative hemorrhage volume were 630 min and 600 mL,respectively.Omentectomy was performed in 32 cases of primary ovarian cancer and 24 cases of recurrence.The median peritoneal cancer index was 16.The risk factors for delayed gastric emptying from the univariate analysis were body mass index<23 kg/m2(X2=5.059,P=0.025),history of pelvic surgery(X^(2)=4.498,P=0.034),history of chemotherapy(X^(2)=4.334,P=0.037),operation time≥7 h(X2=4.827,P=0.047),and intraoperative hemorrhage≥800 mL(X^(2)=7.112,P=0.008).Multivariable analysis revealed that age≥70 years(HR=7.127;95%CI 1.122-45.264;P=0.037)and intraoperative

关键词： delayed gastric emptying Cytoreductive surgery Hyperthermic intraperitoneal chemotherapy Ovarian cancer Complication Nasogastric tube

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Gastroparesis:New insights into an old disease

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World Journal of Gastroenterology 2020年第19期26卷 2333-2348页

作者： Paolo Usai-Satta Massimo Bellini Olivia Morelli Francesca Geri Mariantonia Lai Gabrio Bassotti Department of Internal Medicine Division of GastroenterologyBrotzu HospitalCagliari 09124Italy Gastrointestinal Unit Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisa 56122Italy Gastroenterology and Hepatology Section Department of MedicineUniversity of Perugia Medical SchoolPerugia 06123Italy Gastroenterology Unit University of CagliariMonserrato 09042Italy

Gastroparesis(Gp)is a chronic disease characterized by a delayed gastric emptying in the absence of mechanical obstruction.Although this condition has been reported in the literature since the mid-1900s,only recently has there been renewed clinical and scientific interest in this disease,which has a potentially great impact on the quality of life.The aim of this review is to explore the pathophysiological,diagnostic and therapeutical aspects of Gp according to the most recent evidence.A comprehensive online search for Gp was carried out using MEDLINE and EMBASE.Gp is the result of neuromuscular abnormalities of the gastric motor function.There is evidence that patients with idiopathic and diabetic Gp may display a reduction in nitrergic inhibitory neurons and in interstitial cells of Cajal and/or telocytes.As regards diagnostic approach,99-Technetium scintigraphy is currently considered to be the gold standard for Gp.Its limits are a lack of standardization and a mild risk of radiation exposure.The C13 breath testing is a valid and safe alternative method.13C acid octanoic and the 13C Spirulina platensis recently approved by the Food and Drug Administration are the most commonly used diagnostic kits.The wireless motility capsule is a promising technique,but its use is limited by costs and scarce availability in many countries.Finally,therapeutic strategies are related to the clinical severity of Gp.In mild and moderate Gp,dietary modification and prokinetic agents are generally sufficient.Metoclopramide is the only drug approved by the Food and Drug Administration for Gp.However,other older and new prokinetics and antiemetics can be considered.As a second-line therapy,tricyclic antidepressants and cannabinoids have been proposed.In severe cases the normal nutritional approach can be compromised and artificial nutrition may be needed.In drug-unresponsive Gp patients some alternative strategies(endoscopic,electric stimulation or surgery)are available.

关键词： Gastroparesis delayed gastric emptying gastric Scintigraphy 13C breath testing Wireless motility capsule Prokinetics Antiemetic drugs gastric-per-oral endoscopic myotomy gastric electrical stimulation

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