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.	黄强, 杨骥, 林先盛, 等. 胰十二指肠切除术 491 例患者术后并发症分析. 中华肝胆外科杂志, 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, 马海, 等. 胰十二指肠切除术后胃瘫综合征的综合治疗. 肝胆胰外科杂志, 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.	张鑫, 王宝胜. 胰十二指肠切除术后胃排空障碍的危险因素分析及治疗. 中国医科大学学报, 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.	蒋康怡, 高峰畏, 雷泽华, 等. 全腹腔镜与开腹胰十二指肠切除术比较的非 RCT 研究的 meta 分析. 中国普外基础与临床杂志, 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.	刘荣, 李吉喆. 达芬奇机器人胰十二指肠切除关键技术与注意事项. 中华普外科手术学杂志(电子版), 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. 加速康复外科应用于胰腺切除围术期安全性和可行性的 Meta 分析. 中华消化外科杂志, 2018, 17(7): 729-739.
30.	中华医学会外科学分会中华医学会麻醉学分会. 加速康复外科中国专家共识暨路径管理指南(2018). 中华麻醉学杂志, 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.	许海蓉, 叶必星, 司新敏, 等. 内镜下幽门括约肌切开术治疗难治性胃瘫的研究进展. 中华消化内镜杂志, 2017, 34(3): 220-222.
38.	戴伟钢, 董文广. 胰十二指肠切除术后胃排空障碍循证治疗策略. 消化肿瘤杂志(电子版), 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.	谭宏涛, 宗岩, 赵战强, 等. 胰十二指肠切除术后胃排空延迟预后预测系统的建立和应用. 中华外科杂志, 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. 黄强, 杨骥, 林先盛, 等. 胰十二指肠切除术 491 例患者术后并发症分析. 中华肝胆外科杂志, 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, 马海, 等. 胰十二指肠切除术后胃瘫综合征的综合治疗. 肝胆胰外科杂志, 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. 张鑫, 王宝胜. 胰十二指肠切除术后胃排空障碍的危险因素分析及治疗. 中国医科大学学报, 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. 蒋康怡, 高峰畏, 雷泽华, 等. 全腹腔镜与开腹胰十二指肠切除术比较的非 RCT 研究的 meta 分析. 中国普外基础与临床杂志, 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. 刘荣, 李吉喆. 达芬奇机器人胰十二指肠切除关键技术与注意事项. 中华普外科手术学杂志(电子版), 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. 加速康复外科应用于胰腺切除围术期安全性和可行性的 Meta 分析. 中华消化外科杂志, 2018, 17(7): 729-739.
30. 中华医学会外科学分会中华医学会麻醉学分会. 加速康复外科中国专家共识暨路径管理指南(2018). 中华麻醉学杂志, 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. 许海蓉, 叶必星, 司新敏, 等. 内镜下幽门括约肌切开术治疗难治性胃瘫的研究进展. 中华消化内镜杂志, 2017, 34(3): 220-222.
38. 戴伟钢, 董文广. 胰十二指肠切除术后胃排空障碍循证治疗策略. 消化肿瘤杂志(电子版), 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. 谭宏涛, 宗岩, 赵战强, 等. 胰十二指肠切除术后胃排空延迟预后预测系统的建立和应用. 中华外科杂志, 2017, 55(5): 368-372.

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Research progress of delayed gastric emptying after pancreaticoduodenectomy

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