Meta-analysis of risk factors of delayed gastric emptying after pancreaticoduodenectomy

Abstract

Objective To investigate the risk factors of delayed gastric emptying (DGE) after pancreaticoduodenectomy, in order to provide a theoretical basis for prevention and treatment of this complication. Methods The term DGE was searched in Pubmed, Medline, EMBASE, Cochrane Library, CNKI, Wanfang, and published literatures were collected to determine the risk factors of DGE after pancreaticoduodenectomy. The Review Manager 5.3 software was used in the analysis. Results A total of 52 articles were included. The results of Meta-analysis showed that age and preoperative bilirubin levels did not significantly influence the incidence of DGE. Preoperative cholangitis (OR=3.39, 95%CI 1.97~5.82), hypoalbuminemia (OR=2.53, 95%CI 1.59~4.02), and intraoperative blood loss of more than 1L (OR=1.98, 95%CI 1.18~3.33) significantly increased the incidence of DGE. Pyloric resection (RR=2.06, 95% CI 1.05~4.05), antecolic reconstruction (RR=0.74, 95%CI 0.56~0.99) and Braun enteroenterostomy (OR=0.36, 95%CI 0.17~0.77) significantly decreased the risk of DGE. When compared with Roux-en-Y enteroenterostomy, Billroth Ⅱ enteroenterostomy reduced the incidence of clinically relevant DGE (RR=0.30, 95%CI 0.11~0.79). Postoperative pancreatic fistula (OR=3.84, 95%CI 2.71~5.44) and intra-abdominal infection/abscess (OR=3.95, 95%CI 2.87~5.43) were significantly associated with a high incidence of DGE. Conclusions Hypoalbuminemia, cholangitis, large blood loss, and postoperative abdominal complications were the risk factors of DGE. Pyloric resection, antecolic reconstruction, Billroth Ⅱ enteroenterostomy, and Braun enteroenterostomy significantly reduced the incidence of DGE. Subgroup analysis showed that differences on DGE definition in studies might be an important cause for the heterogeneity in the results of the different studies. Key words: Pancreaticoduodenectomy; Delayed gastric emptying; Meta-analysis