Research progress of delayed gastric emptying after pancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Xiang , WANG Cheng ,  WU Buqiang

Department of Hepatobiliary Surgery, Peace Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P. R. China;

Corresponding?author：

WU Buqiang, Email: wuli67@163.com

Keywords：

pancreaticoduodenectomy; delayed gastric emptying; therapy

DOI：

10.7507/1007-9424.201908070

Video：

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Objective To discuss the current status and progress of delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD).Method The related researches about DGE after PD in recent year were searched and reviewed.Results The etiology and pathogenesis of DGE had not yet been fully elucidated. There were various risk factors, such as the surgical trauma, advanced age, diabetes, and with other abdominal complications. The pylorus preserving PD didn’t increase the risk of DGE. The pylorus ring resection, anterior colon, Braun anastomosis, and minimally invasive surgery were beneficial for reducing DGE. Although there was no obvious progress in the treatment of DGE at home and abroad, the majority of patients could be cured by the symptomatic conservative treatment.Conclusions Prevention is a main strategy for DGE after PD. Application of enhanced recovery after surgery might be a key to solve problem in clinical, but further research is needed.

Citation： LIU Xiang, WANG Cheng, WU Buqiang. Research progress of delayed gastric emptying after pancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(5): 641-645. doi: 10.7507/1007-9424.201908070 Copy

1.	Sasturkar SV, Pamecha V. Factors influencing readmission after pancreaticoduodenectomy: a multi-institutional study of 1 302 patients. Ann Surg, 2014, 259(4): e72.
2.	黃強, 楊驥, 林先盛, 等. 胰十二指腸切除術 491 例患者術后并發癥分析. 中華肝膽外科雜志, 2018, 24(2): 126-127.
3.	Jung JP, Zenati MS, Dhir M, et al. Use of video review to investigate technical factors that may be associated with delayed gastric emptying after pancreaticoduodenectomy. JAMA Surg, 2018, 153(10): 918-927.
4.	Miyazaki Y, Oda T, Shimomura O, et al. Retrocolic gastrojejunostomy after pancreaticoduodenectomy: A satisfactory delayed gastric-emptying rate. Pancreas, 2019, 48(4): 579-584.
5.	黎官印, 彭勇, 馬海, 等. 胰十二指腸切除術后胃癱綜合征的綜合治療. 肝膽胰外科雜志, 2017, 29(4): 308-310, 342.
6.	Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007, 142(5): 761-768.
7.	Ellis RJ, Gupta AR, Hewitt DB, et al. Risk factors for post-pancreaticoduodenectomy delayed gastric emptying in the absence of pancreatic fistula or intra-abdominal infection. J Surg Oncol, 2019, 119(7): 925-931.
8.	Robinson JR, Marincola P, Shelton J, et al. Peri-operative risk factors for delayed gastric emptying after a pancreaticoduodenectomy. HPB (Oxford), 2015, 17(6): 495-501.
9.	Hasler WL. Gastroparesis: pathogenesis, diagnosis and management. Nat Rev Gastroenterol Hepatol, 2011, 8(8): 438-453.
10.	Greene JG, Noorian AR, Srinivasan S. Delayed gastric emptying and enteric nervous system dysfunction in the rotenone model of Parkinson’s disease. Exp Neurol, 2009, 218(1): 154-161.
11.	Ogawa A, Mochiki E, Yanai M, et al. Interdigestive migrating contractions are coregulated by ghrelin and motilin in conscious dogs. Am J Physiol Regul Integr Comp Physiol, 2012, 302(2): R233-R241.
12.	張鑫, 王寶勝. 胰十二指腸切除術后胃排空障礙的危險因素分析及治療. 中國醫科大學學報, 2019, 48(6): 537-541.
13.	Laaninen M, Sand J, Nordback I, et al. Perioperative hydrocor-tisone reduces major complications after pancreaticoduodenectomy: A randomized controlled trial. Ann Surg, 2016, 264(5): 696-702.
14.	Klaiber U, Probst P, Strobel O, et al. Meta-analysis of delayed gastric emptying after pylorus-preserving versus pylorus-resecting pancreatoduodenectomy. Br J Surg, 2018, 105(4): 339-349.
15.	Hackert T, Probst P, Knebel P, et al. Pylorus resection does not reduce delayed gastric emptying after partial pancreato duodenectomy: A Blinded Randomized Controlled Trial (PROPP Study, DRKS00004191). Ann Surg, 2018, 267(6): 1021-1027.
16.	Hanna MM, Tamariz L, Gadde R, et al. Delayed gastric emptying after pylorus preserving pancreaticoduodenectomy-does gastrointestinal reconstruction technique matter? Am J Surg, 2016, 211(4): 810-819.
17.	Kawai M, Tani M, Hirono S, et al. Pylorus ring resection reduces delayed gastric emptying in patients undergoing pancreato duodenectomy: a prospective, randomized, controlled trial of pylorus-resecting versus pylorus-preserving pancreato duodenectomy. Ann Surg, 2011, 253(3): 495-501.
18.	Yang SH, Dou KF, Sharma N, et al. The methods of reconstruction of pancreatic digestive continuity after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. World J Surg, 2011, 35(10): 2290-2297.
19.	Busquets J, Martín S, Fabregat J, et al. Randomized trial of two types of gastrojejunostomy after pancreatoduodenectomy and risk of delayed gastric emptying (PAUDA trial). Br J Surg, 2019, 106(1): 46-54.
20.	Tani M, Kawai M, Hirono S, et al. Randomized clinical trial of isolated Roux-en-Y versus conventional reconstruction after pancreaticoduodenectomy. Br J Surg, 2014, 101(9): 1084-1091.
21.	Zhou Y, Hu B, Wei K, et al. Braun anastomosis lowers the incidence of delayed gastric emptying following pancreatico duodenectomy: a meta-analysis. BMC Gastroenterol, 2018, 18(1): 176.
22.	Fujieda H, Yokoyama Y, Hirata A, et al. Does Braun anastomosis have an impact on the incidence of delayed gastric emptying and the extent of intragastric bile reflux following pancreatoduo denectomy? -A Randomized Controlled Study. Dig Surg, 2017, 34(6): 462-468.
23.	Wang M, Peng B, Liu J, et al. Practice patterns and perioperative outcomes of laparoscopic pancreaticoduodenectomy in China: A retrospective multicenter analysis of 1 029 patients. Ann Surg, 2019 Jan 17. doi: 10.1097/SLA.0000000000003190.
24.	蔣康怡, 高峰畏, 雷澤華, 等. 全腹腔鏡與開腹胰十二指腸切除術比較的非 RCT 研究的 meta 分析. 中國普外基礎與臨床雜志, 2019, 26(4): 448-457.
25.	McMillan MT, Zureikat AH, Hogg ME, et al. A propensity score-matched analysis of robotic vs open pancreatoduodenectomy on incidence of pancreatic fistula. JAMA Surg, 2017, 152(4): 327-335.
26.	Rosemurgy A, Ross S, Bourdeau T, et al. Robotic pancreaticoduo denectomy is the future: here and now. J Am Coll Surg, 2019, 228(4): 613-624.
27.	劉榮, 李吉喆. 達芬奇機器人胰十二指腸切除關鍵技術與注意事項. 中華普外科手術學雜志(電子版), 2019, 13(4): 336-339.
28.	Takagi K, Yoshida R, Yagi T, et al. Effect of an enhanced recovery after surgery protocol in patients undergoing pancreatico duodenectomy: A randomized controlled trial. Clin Nutr, 2019, 38(1): 174-181.
29.	任超逸, 白同, 崔巍, 等. 加速康復外科應用于胰腺切除圍術期安全性和可行性的 Meta 分析. 中華消化外科雜志, 2018, 17(7): 729-739.
30.	中華醫學會外科學分會中華醫學會麻醉學分會. 加速康復外科中國專家共識暨路徑管理指南(2018). 中華麻醉學雜志, 2018, 38(1): 8-13.
31.	Sulzer JK, Sastry AV, Meyer LM, et al. The impact of intraoperative goal-directed fluid therapy on complications after pancreaticoduodenectomy. Ann Med Surg (Lond), 2018, 36: 23-28.
32.	Navez J, Hubert C, Dokmak S, et al. Early versus late oral refeeding after pancreaticoduodenectomy for malignancy: a comparative Belgian-French study in two tertiary centers. J Gastrointest Surg, 2019 Jul 19. doi: 10.1007/s11605-019-04316-8.
33.	Shen Y, Jin W. Early enteral nutrition after pancreato duodenectomy: a meta-analysis of randomized controlled trials. Langenbecks Arch Surg, 2013, 398(6): 817-823.
34.	Camilleri M. Novel diet, drugs, and gastric interventions for gastroparesis. Clin Gastroenterol Hepatol, 2016, 14(8): 1072-1080.
35.	Kendall BJ, Kendall ET, Soykan I, et al. Cisapride in the long-term treatment of chronic gastroparesis: a 2-year open-label study. J Int Med Res, 1997, 25(4): 182-189.
36.	Ohwada S, Satoh Y, Kawate S, et al. Low-dose erythromycin reduces delayed gastric emptying and improves gastric motility after Billroth Ⅰ pylorus-preserving pancreaticoduodenectomy. Ann Surg, 2001, 234(5): 668-674.
37.	許海蓉, 葉必星, 司新敏, 等. 內鏡下幽門括約肌切開術治療難治性胃癱的研究進展. 中華消化內鏡雜志, 2017, 34(3): 220-222.
38.	戴偉鋼, 董文廣. 胰十二指腸切除術后胃排空障礙循證治療策略. 消化腫瘤雜志(電子版), 2011, 3(3): 184-188.
39.	Guerci B, Bourgeois C, Bresler L, et al. Gastric electrical stimulation for the treatment of diabetic gastroparesis. Diabetes Metab, 2012, 38(5): 393-402.
40.	譚宏濤, 宗巖, 趙戰強, 等. 胰十二指腸切除術后胃排空延遲預后預測系統的建立和應用. 中華外科雜志, 2017, 55(5): 368-372.

1. Sasturkar SV, Pamecha V. Factors influencing readmission after pancreaticoduodenectomy: a multi-institutional study of 1 302 patients. Ann Surg, 2014, 259(4): e72.
2. 黃強, 楊驥, 林先盛, 等. 胰十二指腸切除術 491 例患者術后并發癥分析. 中華肝膽外科雜志, 2018, 24(2): 126-127.
3. Jung JP, Zenati MS, Dhir M, et al. Use of video review to investigate technical factors that may be associated with delayed gastric emptying after pancreaticoduodenectomy. JAMA Surg, 2018, 153(10): 918-927.
4. Miyazaki Y, Oda T, Shimomura O, et al. Retrocolic gastrojejunostomy after pancreaticoduodenectomy: A satisfactory delayed gastric-emptying rate. Pancreas, 2019, 48(4): 579-584.
5. 黎官印, 彭勇, 馬海, 等. 胰十二指腸切除術后胃癱綜合征的綜合治療. 肝膽胰外科雜志, 2017, 29(4): 308-310, 342.
6. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007, 142(5): 761-768.
7. Ellis RJ, Gupta AR, Hewitt DB, et al. Risk factors for post-pancreaticoduodenectomy delayed gastric emptying in the absence of pancreatic fistula or intra-abdominal infection. J Surg Oncol, 2019, 119(7): 925-931.
8. Robinson JR, Marincola P, Shelton J, et al. Peri-operative risk factors for delayed gastric emptying after a pancreaticoduodenectomy. HPB (Oxford), 2015, 17(6): 495-501.
9. Hasler WL. Gastroparesis: pathogenesis, diagnosis and management. Nat Rev Gastroenterol Hepatol, 2011, 8(8): 438-453.
10. Greene JG, Noorian AR, Srinivasan S. Delayed gastric emptying and enteric nervous system dysfunction in the rotenone model of Parkinson’s disease. Exp Neurol, 2009, 218(1): 154-161.
11. Ogawa A, Mochiki E, Yanai M, et al. Interdigestive migrating contractions are coregulated by ghrelin and motilin in conscious dogs. Am J Physiol Regul Integr Comp Physiol, 2012, 302(2): R233-R241.
12. 張鑫, 王寶勝. 胰十二指腸切除術后胃排空障礙的危險因素分析及治療. 中國醫科大學學報, 2019, 48(6): 537-541.
13. Laaninen M, Sand J, Nordback I, et al. Perioperative hydrocor-tisone reduces major complications after pancreaticoduodenectomy: A randomized controlled trial. Ann Surg, 2016, 264(5): 696-702.
14. Klaiber U, Probst P, Strobel O, et al. Meta-analysis of delayed gastric emptying after pylorus-preserving versus pylorus-resecting pancreatoduodenectomy. Br J Surg, 2018, 105(4): 339-349.
15. Hackert T, Probst P, Knebel P, et al. Pylorus resection does not reduce delayed gastric emptying after partial pancreato duodenectomy: A Blinded Randomized Controlled Trial (PROPP Study, DRKS00004191). Ann Surg, 2018, 267(6): 1021-1027.
16. Hanna MM, Tamariz L, Gadde R, et al. Delayed gastric emptying after pylorus preserving pancreaticoduodenectomy-does gastrointestinal reconstruction technique matter? Am J Surg, 2016, 211(4): 810-819.
17. Kawai M, Tani M, Hirono S, et al. Pylorus ring resection reduces delayed gastric emptying in patients undergoing pancreato duodenectomy: a prospective, randomized, controlled trial of pylorus-resecting versus pylorus-preserving pancreato duodenectomy. Ann Surg, 2011, 253(3): 495-501.
18. Yang SH, Dou KF, Sharma N, et al. The methods of reconstruction of pancreatic digestive continuity after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. World J Surg, 2011, 35(10): 2290-2297.
19. Busquets J, Martín S, Fabregat J, et al. Randomized trial of two types of gastrojejunostomy after pancreatoduodenectomy and risk of delayed gastric emptying (PAUDA trial). Br J Surg, 2019, 106(1): 46-54.
20. Tani M, Kawai M, Hirono S, et al. Randomized clinical trial of isolated Roux-en-Y versus conventional reconstruction after pancreaticoduodenectomy. Br J Surg, 2014, 101(9): 1084-1091.
21. Zhou Y, Hu B, Wei K, et al. Braun anastomosis lowers the incidence of delayed gastric emptying following pancreatico duodenectomy: a meta-analysis. BMC Gastroenterol, 2018, 18(1): 176.
22. Fujieda H, Yokoyama Y, Hirata A, et al. Does Braun anastomosis have an impact on the incidence of delayed gastric emptying and the extent of intragastric bile reflux following pancreatoduo denectomy? -A Randomized Controlled Study. Dig Surg, 2017, 34(6): 462-468.
23. Wang M, Peng B, Liu J, et al. Practice patterns and perioperative outcomes of laparoscopic pancreaticoduodenectomy in China: A retrospective multicenter analysis of 1 029 patients. Ann Surg, 2019 Jan 17. doi: 10.1097/SLA.0000000000003190.
24. 蔣康怡, 高峰畏, 雷澤華, 等. 全腹腔鏡與開腹胰十二指腸切除術比較的非 RCT 研究的 meta 分析. 中國普外基礎與臨床雜志, 2019, 26(4): 448-457.
25. McMillan MT, Zureikat AH, Hogg ME, et al. A propensity score-matched analysis of robotic vs open pancreatoduodenectomy on incidence of pancreatic fistula. JAMA Surg, 2017, 152(4): 327-335.
26. Rosemurgy A, Ross S, Bourdeau T, et al. Robotic pancreaticoduo denectomy is the future: here and now. J Am Coll Surg, 2019, 228(4): 613-624.
27. 劉榮, 李吉喆. 達芬奇機器人胰十二指腸切除關鍵技術與注意事項. 中華普外科手術學雜志(電子版), 2019, 13(4): 336-339.
28. Takagi K, Yoshida R, Yagi T, et al. Effect of an enhanced recovery after surgery protocol in patients undergoing pancreatico duodenectomy: A randomized controlled trial. Clin Nutr, 2019, 38(1): 174-181.
29. 任超逸, 白同, 崔巍, 等. 加速康復外科應用于胰腺切除圍術期安全性和可行性的 Meta 分析. 中華消化外科雜志, 2018, 17(7): 729-739.
30. 中華醫學會外科學分會中華醫學會麻醉學分會. 加速康復外科中國專家共識暨路徑管理指南(2018). 中華麻醉學雜志, 2018, 38(1): 8-13.
31. Sulzer JK, Sastry AV, Meyer LM, et al. The impact of intraoperative goal-directed fluid therapy on complications after pancreaticoduodenectomy. Ann Med Surg (Lond), 2018, 36: 23-28.
32. Navez J, Hubert C, Dokmak S, et al. Early versus late oral refeeding after pancreaticoduodenectomy for malignancy: a comparative Belgian-French study in two tertiary centers. J Gastrointest Surg, 2019 Jul 19. doi: 10.1007/s11605-019-04316-8.
33. Shen Y, Jin W. Early enteral nutrition after pancreato duodenectomy: a meta-analysis of randomized controlled trials. Langenbecks Arch Surg, 2013, 398(6): 817-823.
34. Camilleri M. Novel diet, drugs, and gastric interventions for gastroparesis. Clin Gastroenterol Hepatol, 2016, 14(8): 1072-1080.
35. Kendall BJ, Kendall ET, Soykan I, et al. Cisapride in the long-term treatment of chronic gastroparesis: a 2-year open-label study. J Int Med Res, 1997, 25(4): 182-189.
36. Ohwada S, Satoh Y, Kawate S, et al. Low-dose erythromycin reduces delayed gastric emptying and improves gastric motility after Billroth Ⅰ pylorus-preserving pancreaticoduodenectomy. Ann Surg, 2001, 234(5): 668-674.
37. 許海蓉, 葉必星, 司新敏, 等. 內鏡下幽門括約肌切開術治療難治性胃癱的研究進展. 中華消化內鏡雜志, 2017, 34(3): 220-222.
38. 戴偉鋼, 董文廣. 胰十二指腸切除術后胃排空障礙循證治療策略. 消化腫瘤雜志(電子版), 2011, 3(3): 184-188.
39. Guerci B, Bourgeois C, Bresler L, et al. Gastric electrical stimulation for the treatment of diabetic gastroparesis. Diabetes Metab, 2012, 38(5): 393-402.
40. 譚宏濤, 宗巖, 趙戰強, 等. 胰十二指腸切除術后胃排空延遲預后預測系統的建立和應用. 中華外科雜志, 2017, 55(5): 368-372.

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Research progress of delayed gastric emptying after pancreaticoduodenectomy

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