Risk Factors for Delayed Gastric Emptying after Pancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 AIMAIER·Maierdan , CHOUMAN Sulidankazha ,  HANWei , CHENQi-long , LINHai , HETie-ying , CAOXing-hua , RUIJian-rui

Department of Pancreatic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China;

Corresponding author：

HANWei, Email: 13999846637@139.com

Keywords：

Delayed gastric emptying; Pancreatoduodenectomy; Risk factor

DOI：

10.7507/1007-9424.20150087

Video：

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Objective To analyze the risk factors for delayed gastric emptying (DGE) after pancreaticoduodenec-tomy (PD). Methods Clinical data of 67 patients who underwent PD in our hospital from September 2012 to June 2014 were retrospectively analyzed. Results Twenty-two patients were complicated with DGE of the 67 patients (32.8%) after PD operation. Univariate analysis showed that, diabetes mellitus, the anastomosis methods for stomach and jejunum, and diameter of circular stapler were risk factors for postoperative DGE, the patients who complicated with diabetes mellitus, treated with the traditional Child plus Braun anastomosis method, and treated with 25 mm circular stapler had higher incidence of DGE than patients who didn't complicate with diabetes mellitus, treated with Roux-en-Y anastomosis method, and treated with 28 mm circular stapler (P<0.05). Logistic regression identified 2 variables as independent risk factors which were associated with postoperative DGE, namely, anastomosis methods for stomach and jejunum (OR=0.062,95% CI:0.009-0.407,P=0.004) and diameter of circular stapler (OR=0.135,95% CI:0.034-0.538,P=0.005). The patients who treated with traditional Child plus Braun anastomosis method and 25 mm circular stapler had higher incidence of DGE. Conclusions The incidence of DGE after PD is still high. The incidence of DGE could be reduced by using Roux-en-Y method to reconstruct digestive tract and 28 mm circular stapler during PD operation.

Citation： AIMAIER·Maierdan, CHOUMAN Sulidankazha, HANWei, CHENQi-long, LINHai, HETie-ying, CAOXing-hua, RUIJian-rui. Risk Factors for Delayed Gastric Emptying after Pancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(3): 326-330. doi: 10.7507/1007-9424.20150087 Copy

1.	Rios G, Conrad A, Cole D, et al. Trends in indications and outcomes in the Whipple procedure over a 40-year period. Am Surg, 1999, 65(9):889-893.
2.	Yeo CJ, Barry MK, Sauter PK, et al. Erythromycin accelerates gastricemptying after pancreaticoduodenectomy. A prospective, rando-mized, placebo-controlled trial. Ann Surg, 1993, 218(3):229-237.
3.	Osada S, Imai H, Sasaki Y, et al. Reconstruction method after pancreaticoduodenectomy. Idea to prevent serious complications. JOP, 2012, 13(1):1-6.
4.	Park YC, Kim SW, Jang JY, et al. Factors influencing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. J Am Coll Surg, 2003, 196(6):859-865.
5.	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.
6.	Bar-Natan M, Larson GM, Stephens G, et al. Delayed gastric emptying after gastric surgery. Am J Surg, 1996, 172(1):24-28.
7.	Tanaka M, Sarr MG. Total duodenectomy:effect on canine gastrointestinal motility. J Surg Res, 1987, 42(5):483-493.
8.	Chu CK, Mazo AE, Goodaman M, et al. Preoperative diabetes mellitus and long-term survival after resection of pancreatic adenocarcinoma. Ann Surg Oncol, 2010, 17(2):502-513.
9.	Ueno T, Tanaka A, Hamanaka Y, et al. A proposal mechanism ofearly delayed gastric emptying after pylorus preserving pancreato-duodenectomy. Hepatogastroenterology, 1995, 42(3):269-274.
10.	Hellmig S, Von Schöning F, Gadow C, et al. Gastric emptying time of fluids and solids in healthy subjects determined by 13C breath tests:influence of age, sex and body mass index. J Gastroenterol Hepatol, 2006, 21(12):1832-1838.
11.	Lermite E, Pessaux P, Brehant O, et al. Risk factors of pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg, 2007, 204(4):588-596.
12.	Horowitz M, Maddern GJ, Chatterton BE, et al. Changes in gastric emptying rates with age. Clin Sci (Lond), 1984, 67(2):213-218.
13.	Yeo CJ, Cameron JL, Sohn TA, et al. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma:comparison of morbidity and mortality and short-term outcome. Ann Surg, 1999, 229(5):613-624.
14.	Samsom M, Smout AJ. Abnormal gastric and small intestinal motor function in diabetes mellitus. Dig Dis, 1997, 15(4-5):263-274.
15.	Rayner CK, Samsom M, Jones KL, et al. Relationships of upper gastrointestinal motor and sensory function with glycemic control. Diabetes Care, 2001, 24(2):371-381.
16.	Shafi MA, Pasticha PJ. Post-surgical and obstructive gastroparesis. Curr Gastroenterol Rep, 2007, 9(4):280-285.
17.	Barnett JL, Owyang C. Serum glucose concentration as a modulator of interdigestive gastric motility. Gastroenterology, 1988, 94(3):739-744.
18.	Sakamoto Y, Kajiwara T, Esaki M, et al. Roux-en-Y reconstruction using staplers during pancreaticoduodenectomy:results of a prospective preliminary study. Surg Today, 2009, 39(1):32-37.
19.	Kim KH, Kim MC, Jung GJ. Risk factors associated with delayed gastric emptying after subtotal gastrectomy with Billroth- Ⅰ anasto-mosis using circular stapler for early gastric cancer patients. J Korean Surg Soc, 2012, 83(5):274-280.
20.	杜家文, 宁武, 裴东坡, 等. 胰十二指肠切除术后胃排空障碍危险因素的Logistic回归分析. 中华肝胆外科杂志, 2009, 15(5):365-367.
21.	魏桂菊, 胡芳, 巍秋玲. 胰十二指肠切除术后胃排空延迟危险因素分析及护理. 护士进修杂志, 2014, 3(3):256-257.
22.	王志军, 李珂, 谢志徽, 等. 保留幽门的胰十二指肠切除术与Whipple术早期疗效比较. 实用诊断与治疗杂志, 2005, 19(2):104-105.
23.	Sugiyama M, Abe N, Ueki H, et al. A new reconstruction method for preventing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. Am J Surg, 2004, 187(6):743-746.
24.	Tani M, Terasawa H, Kawai M, et al. Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy:results of a prospective, randomized, controlled trial. Ann Surg, 2006, 243(3):316-320.
25.	Horstmann O, Markus PM, Ghadimi MB, et al. Pylorus preserva-tion has no impact on delayed gastric emptying after pancreatic head resection. Pancreas, 2004, 28(1):69-74.
26.	Mecray PM, Barden RP, Ravdin IS. Nutritional edema:its effect on the gastric emptying time before and after gastric operations. 1937. Nutrition, 1990, 6(4):278-290.
27.	Ohwada S, Satoh Y, Kawate S, et al. Low-dose erythromycin reducesdelayed gastric emptying and improves gastric motility after Billroth Ⅰpylorus-preserving pancreaticoduodenectomy. Ann Surg, 2001, 234(5):668-674.
28.	董科奇, 邓杰. 针刺足三里治疗机械通气患者胃排空障碍疗效观察. 浙江中西医结合杂志, 2013, 1(1):29-30.
29.	邹宏雷, 杜鹃. 腹部手术后胃瘫的诊治分析23例报道. 中国普外基础与临床杂志, 2012, 19(10):1148.

1. Rios G, Conrad A, Cole D, et al. Trends in indications and outcomes in the Whipple procedure over a 40-year period. Am Surg, 1999, 65(9):889-893.
2. Yeo CJ, Barry MK, Sauter PK, et al. Erythromycin accelerates gastricemptying after pancreaticoduodenectomy. A prospective, rando-mized, placebo-controlled trial. Ann Surg, 1993, 218(3):229-237.
3. Osada S, Imai H, Sasaki Y, et al. Reconstruction method after pancreaticoduodenectomy. Idea to prevent serious complications. JOP, 2012, 13(1):1-6.
4. Park YC, Kim SW, Jang JY, et al. Factors influencing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. J Am Coll Surg, 2003, 196(6):859-865.
5. 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.
6. Bar-Natan M, Larson GM, Stephens G, et al. Delayed gastric emptying after gastric surgery. Am J Surg, 1996, 172(1):24-28.
7. Tanaka M, Sarr MG. Total duodenectomy:effect on canine gastrointestinal motility. J Surg Res, 1987, 42(5):483-493.
8. Chu CK, Mazo AE, Goodaman M, et al. Preoperative diabetes mellitus and long-term survival after resection of pancreatic adenocarcinoma. Ann Surg Oncol, 2010, 17(2):502-513.
9. Ueno T, Tanaka A, Hamanaka Y, et al. A proposal mechanism ofearly delayed gastric emptying after pylorus preserving pancreato-duodenectomy. Hepatogastroenterology, 1995, 42(3):269-274.
10. Hellmig S, Von Schöning F, Gadow C, et al. Gastric emptying time of fluids and solids in healthy subjects determined by 13C breath tests:influence of age, sex and body mass index. J Gastroenterol Hepatol, 2006, 21(12):1832-1838.
11. Lermite E, Pessaux P, Brehant O, et al. Risk factors of pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg, 2007, 204(4):588-596.
12. Horowitz M, Maddern GJ, Chatterton BE, et al. Changes in gastric emptying rates with age. Clin Sci (Lond), 1984, 67(2):213-218.
13. Yeo CJ, Cameron JL, Sohn TA, et al. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma:comparison of morbidity and mortality and short-term outcome. Ann Surg, 1999, 229(5):613-624.
14. Samsom M, Smout AJ. Abnormal gastric and small intestinal motor function in diabetes mellitus. Dig Dis, 1997, 15(4-5):263-274.
15. Rayner CK, Samsom M, Jones KL, et al. Relationships of upper gastrointestinal motor and sensory function with glycemic control. Diabetes Care, 2001, 24(2):371-381.
16. Shafi MA, Pasticha PJ. Post-surgical and obstructive gastroparesis. Curr Gastroenterol Rep, 2007, 9(4):280-285.
17. Barnett JL, Owyang C. Serum glucose concentration as a modulator of interdigestive gastric motility. Gastroenterology, 1988, 94(3):739-744.
18. Sakamoto Y, Kajiwara T, Esaki M, et al. Roux-en-Y reconstruction using staplers during pancreaticoduodenectomy:results of a prospective preliminary study. Surg Today, 2009, 39(1):32-37.
19. Kim KH, Kim MC, Jung GJ. Risk factors associated with delayed gastric emptying after subtotal gastrectomy with Billroth- Ⅰ anasto-mosis using circular stapler for early gastric cancer patients. J Korean Surg Soc, 2012, 83(5):274-280.
20. 杜家文, 宁武, 裴东坡, 等. 胰十二指肠切除术后胃排空障碍危险因素的Logistic回归分析. 中华肝胆外科杂志, 2009, 15(5):365-367.
21. 魏桂菊, 胡芳, 巍秋玲. 胰十二指肠切除术后胃排空延迟危险因素分析及护理. 护士进修杂志, 2014, 3(3):256-257.
22. 王志军, 李珂, 谢志徽, 等. 保留幽门的胰十二指肠切除术与Whipple术早期疗效比较. 实用诊断与治疗杂志, 2005, 19(2):104-105.
23. Sugiyama M, Abe N, Ueki H, et al. A new reconstruction method for preventing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. Am J Surg, 2004, 187(6):743-746.
24. Tani M, Terasawa H, Kawai M, et al. Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy:results of a prospective, randomized, controlled trial. Ann Surg, 2006, 243(3):316-320.
25. Horstmann O, Markus PM, Ghadimi MB, et al. Pylorus preserva-tion has no impact on delayed gastric emptying after pancreatic head resection. Pancreas, 2004, 28(1):69-74.
26. Mecray PM, Barden RP, Ravdin IS. Nutritional edema:its effect on the gastric emptying time before and after gastric operations. 1937. Nutrition, 1990, 6(4):278-290.
27. Ohwada S, Satoh Y, Kawate S, et al. Low-dose erythromycin reducesdelayed gastric emptying and improves gastric motility after Billroth Ⅰpylorus-preserving pancreaticoduodenectomy. Ann Surg, 2001, 234(5):668-674.
28. 董科奇, 邓杰. 针刺足三里治疗机械通气患者胃排空障碍疗效观察. 浙江中西医结合杂志, 2013, 1(1):29-30.
29. 邹宏雷, 杜鹃. 腹部手术后胃瘫的诊治分析23例报道. 中国普外基础与临床杂志, 2012, 19(10):1148.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk Factors for Delayed Gastric Emptying after Pancreaticoduodenectomy

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