S0544 Endoscopic Management of Post-Pancreaticoduodenectomy Delayed Gastric Emptying

Abstract

INTRODUCTION: Delayed gastric emptying (DGE) is a common cause of post-operative morbidity after pancreaticoduodenectomy (PD). The etiology of DGE is multifactorial and can include disturbances in muscular, hormonal, and neurologic function affecting overall motility. Endoscopic management has been used in patients with refractory DGE at our institution. We aimed to identify those post-PD patients with DGE who underwent endoscopy, characterize their demographics and risk factors, as well as summarize their outcomes. METHODS: This was a single-center retrospective cohort study evaluating patients who underwent PD between 2017 and 2020. Primary endpoints included modified International Study Group on Pancreas Surgery (ISGPS) DGE severity, endoscopic intervention for DGE, and resolution of DGE symptoms following endoscopy as assessed by time to nasogastric tube removal and toleration of full liquid diet. Secondary endpoints included gender, age, presence of diabetes mellitus (DM) (I or II), type of PD (pylorus-preserving versus classic), type of anastomosis, and post-operative day (POD) of initial DGE symptoms. RESULTS: Of the 281 patients reviewed, DGE developed in 55 (19.6%) patients. Of those with DGE, 34 (61.8%), 13 (23.6%), and 8 (14.5%) were categorized as Grade A, B, and C, respectively, with 9 (16.3%) patients requiring endoscopic evaluation (Table 1). Of the 9 patients who underwent endoscopy, the median age was 67.3 (±12.8) years, 5 (55.6%) were men, none had DM, 4 (44.4%) were classified as Grade B, and 5 (55.6%) were classified as Grade C. The median time to onset of DGE symptoms was 4 days, and the median time to endoscopic intervention was 15 days. Only 1/3 of patients required balloon dilation of stricture or angulation during endoscopy, and 7 (77.8%) patients had immediate improvement in DGE symptoms post-endoscopy. CONCLUSION: Endoscopic intervention may play a role in the treatment of patients that are post-PD with Grade B or higher DGE who are refractory to medical therapies. Our data suggests that regardless of the type of PD or whether balloon dilation is performed endoscopically, patients with grade B or higher DGE may benefit from endoscopy and overall have resolution in their symptoms within one day of the procedure.Table 1