Incidence Of Delayed Gastric Emptying Research Articles

Prospective multicentre randomised controlled trial of the effect of Braun Enteroenterostomy in the Reconstruction after Pancreaticoduodenectomy on delayed gastric emptying (DGE): protocol for the BERP study

IntroductionDespite advances in achieving low mortality rates with pancreaticoduodenectomy (PD), morbidity remains high. A key contributor to this morbidity is delayed gastric emptying (DGE) occurring with an incidence of up...

Delayed gastric emptying after classical Whipple or pylorus-preserving pancreatoduodenectomy: a randomized clinical trial (QUANUPAD)

PurposePylorus-preserving pancreatoduodenectomy (PPPD) has been the gold standard for pancreatic head lesion resection for several years. Some studies have noted that it involves more delayed gastric emptying (DGE) than classical Whipple (i.e., pancreatoduodenectomy with antrectomy). Our working hypothesis was that the classical Whipple has a lower incidence of DGE. We aimed to compare the incidence of DGE among pancreatoduodenectomy techniques.MethodsThis pragmatic, randomized, open-label, single-center clinical trial involved patients who underwent classical Whipple (study group) or PPPD (control group). Gastric emptying was clinically evaluated using scintigraphy. DGE was defined according to the International Study Group of Pancreatic Surgery (ISGPS) criteria. The secondary endpoints were postoperative morbidity, length of hospital stay, anthropometric measurements, and nutritional status.ResultsA total of 84 patients were randomized (42 per group). DGE incidence was 50% (20/40, 95% confidence interval (95% CI): 35–65%) in the study group and 62% (24/39, 95% CI: 46–75%) in the control group (p = 0.260). No differences were observed between both groups regarding postoperative morbidity or length of hospital stay. Anthropometric measurements at 6 months post-surgery: triceps fold measurements were 12 mm and 16 mm (p = 0.021). At 5 weeks post-surgery, triceps fold measurements were 13 mm and 16 mm (p = 0.020) and upper arm circumferences were 26 cm and 28 cm (p = 0.030). No significant differences were observed in nutritional status.ConclusionDGE incidence and severity did not differ between classical Whipple and PPPD. Some anthropometric measurements may indicate a better recovery with PPPD.Trial registrationClinicalTrials.gov Identifier: NCT03984734.

Delayed gastric emptying following distal pancreatectomy: incidence and predisposing factors.

Delayed gastric emptying (DGE) following elective distal pancreatectomy (DP) is poorly known. This study aimed to report incidence of DGE following DP, to identify its predisposing factors, and to assess its impact on hospital stay. Patients who had elective DP without additional organ or vascular resection (2012-2017) in two academic hospitals were included. Factors predisposing to DGE, defined according to the International Study Group of Pancreatic Surgery, were identified by multivariate analysis. A systematic review was performed to evaluate DGE incidence following elective DP. 311 elective DPs were performed. Three perioperative mortalities (1.0%) were unrelated to DGE. DGE occurred in 31 (10.0%) patients (grade A=21, grade B=7, grade C=3) with a median hospital stay of 16 (13-22) days versus 10 (7-14) without DGE (p<0.001). In multivariate analysis, predisposing factors of DGE were age>75 years (OR=4.32 [1.53-12.19]; p=0.006), open approach (OR=2.97 [1.1-8]; p=0.031) and POPF grade B-C (OR=2.54 [1.05-6.1]; p=0.038). The systematic review identified 7 series including 876 patients with an overall 8.1% DGE incidence. DGE complicates around 10% of elective DP. Laparoscopic approach and prevention of POPF should be encouraged to reduce DGE incidence.

The impact of gastrojejunostomy orientation on delayed gastric emptying after pancreaticoduodenectomy: a single center comparative analysis.

Delayed gastric emptying (DGE) represents the most frequent complication after pancreaticoduodenectomy (PD). Aim of this study was to evaluate the impact of gastrojejunostomy (GJ)orientation on DGE incidence after PD. One-hundred and twenty-one consecutive PDs were included in the analysis and divided in the horizontal (H-GJ group) and vertical GJ anastomosis groups (V-GJ group). Postoperative data and the value of the flow angle between the efferent jejunal limb and the stomach of the GJ anastomosis at the upper gastrointestinal series were registered. Seventy-five patients (62%)underwent H-GJ, while 46 patients (38%)underwent V-GJ. The incidence of DGE was significantly lower in the V-GJ group as compared to the H-GJ group (23.9%vs45.3%; p=0.02). V-GJ was also associated to a less severe DGE manifestation (p=0.006). The flow angle was significantly lower in case of V-GJ as compared to H-GJ (24.5°vs37°; p=0.002). At the multivariate analysis, ASA score≥3 (p=0.02), H-GJ (p=0.03), flow angle>30°(p=0.004) and Clavien-Dindo≥3 (p=0.03) were recognized as independent prognostic factors for DGE. These same factors were independent prognostic features also for a more severe DGE manifestation. VGJ and the more acute flow angle appear to be associated to a lower incidence rate and severity of DGE. This modified technique should be considered by surgeons in order to reduce postoperative DGE occurrence.

Delayed Gastric Emptying Post Pancreatic Resection in the Indian Scenario. Is a Revision in Definition Required?

Introduction: Delayed gastric emptying (DGE) is one of the most common complications after pancreatic resection. In the literature, the reported incidence of DGE after pancreatic surgery varies considerably between different surgical centers. The use of various definitions of DGE in homogeneous, single-centre series led to great variety in the reported incidence (20–50%). The aim of this study was to evaluate the incidence of DGE after pancreaticoduodenectomy in the Indian setup.

A Network Meta-Analysis Comparing Gastric Resection Approaches and Enteric Anastomotic Configurations on Delayed Gastric Emptying Following Pancreaticoduodenectomy

Introduction: Delayed gastric emptying (DGE) is frequent following pancreaticoduodenectomy (PD). Several randomized controlled trials (RCTs) have explored operative strategies to minimize DGE, however, the optimal combination of gastric resection approach, anastomotic route, configuration and the use of enteroenterostomy remains unclear. Method: MEDLINE, Embase, and CENTRAL databases were systematically searched for RCTs comparing gastric resection (classic Whipple, pylorus-resecting, pylorus-preserving), anastomotic route (antecolic, retrocolic), configuration (loop gastroenterostomy/Billroth II, Roux-en-Y), and use of Braun enteroenterostomy. A random-effects, Bayesian network meta-analysis with non-informative priors was conducted to determine the optimal combination of approaches to PD for minimizing DGE. Results: A total of 24 RCTs, including 2526 patients and 14 approaches to PD were included. There was some heterogeneity, although inconsistency was low. The overall incidence of DGE was 25.6%. Pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy (Figure 1) was associated with the lowest rates of DGE, and ranked the best in 35% of comparisons. Classic Whipple, retrocolic, Billroth II with Braun enteroenterostomy ranked the worst for DGE, in 32% of comparisons. Pairwise meta-analysis of retrocolic versus antecolic route for gastrojejunostomy found increased risk of DGE with the retrocolic route (OR 2.10, 95% CrI: 0.92-4.70). Pairwise meta-analysis of enteroenterostomy found a trend towards lower DGE rates when a Braun enteroenterostomy was used (OR 1.90, 95% CrI: 0.92-3.90). Conclusions: Based on existing RCT evidence, a pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy seems to be associated with the lowest rates of DGE.

Posterior Circular Stapled GastroJejunostomy After Duodenopancreatectomy.

Anastomotic fistulae are the most common and dreaded postoperative complications of pancreaticoduodenectomy. Delayed gastric emptying (DGE) and slow recovery of bowel function are contributing causes for postoperative pancreatic fistula (PoPF) that should be taken into consideration. The present study evaluates data from 17 consecutive cases that underwent pancreaticoduodenectomy for pancreatic adenocarcinoma with pancreaticojejunal anastomosis and circular stapled mechanical gastrojejunal anastomosis instead of the standard terminolateral technique. Three patients developed Grade A DGE (one also developed grade B PoPF) and one patient required reinsertion of the nasogastric tube due to Grade B PoPF. Overall, the incidence of DGE was 23.5%. Three patients developed Grade B pancreatic fistulae that were successfully managed conservatively. Twelve patients resumed early bowel movement within 4 days, two reinterventions were required for postoperative bleeding. Mean hospital stay was 11.5 days. Patients with DGE had a mean hospital stay of 14.5 days. No gastrojejunostomy leak was encountered. Mortality was nil. Therefore we consider the posterior circular stapled gastrojejunostomy a simple, reproducible, safe technical alternative for avoiding DGE and consequently help lower the risk of PoPF, increased costs associated with prolonged hospital stay and an improved postoperative quality of life.

Modified Technique for Wirsung-Pancreatogastric Anastomosis after Pancreatoduodenectomy: A Single Center Experience and Systematic Review of the Literature.

Background: The mortality rate following pancreaticoduodenectomy (PD) has been decreasing over the past few years; nonetheless, the morbidity rate remains elevated. The most common complications after PD are post-operative pancreatic fistula (POPF) and delayed gastric emptying (DGE) syndrome. The issue as to which is the best reconstruction method for the treatment of the pancreatic remnant after PD is still a matter of debate. The aim of this study was to retrospectively analyze the morbidity rate in 100 consecutive PD reconstructed with Wirsung-Pancreato-Gastro-Anastomosis (WPGA), performed by a single surgeon applying a personal modification of the pancreatic reconstruction technique. Methods: During an 8-year period (May 2012 to March 2020), 100 consecutive patients underwent PD reconstructed with WPGA. The series included 57 males and 43 females (M/F 1.32), with a mean age of 68 (range 41–86) years. The 90-day morbidity and mortality were retrospectively analyzed. Additionally, a systematic review was conducted, comparing our technique with the existing literature on the topic. Results: We observed eight cases of clinically relevant POPF (8%), three cases of “primary” DGE (3%) and four patients suffering “secondary” DGE. The surgical morbidity and mortality rate were 26% and 6%, respectively. The median hospital stay was 13.6 days. The systematic review of the literature confirmed the originality of our modified technique for Wirsung-Pancreato-Gastro-Anastomosis. Conclusions: Our modified double-layer WPGA is associated with a very low incidence of POPF and DGE. Also, the technique avoids the risk of acute hemorrhage of the pancreatic parenchyma.

Impact of additional duodenojejunosotmy- site colonopexy on reduction delayed gastric emptying following pylorus-preserving pancreaticoduodenectomy: A prospective, randomized controlled study

Delayed gastric emptying (DGE) is a major complication after pylorus-preserving pancreaticoduodenectomy (PPPD). Although various hypotheses have been addressed as a cause of DGE following PPPD, the exact mechanism is still unknown. Gastric outlet angle resulted from retraction of duodenojejunostomy (DJ) site toward pancreaticojejunostomy (PJ) site during wound healing process of PJ can lead to mechanical disturbance of ingested food passage. Therefore, additional DJ-colon pexy procedure may reduce the incidence of DGE following PD. From February 2016 to March 2019, 78 patients were recruited for this randomized controlled trial. The incidence of DGE was analyzed according to whether or not DJ-colon pexy was used after PPPD. PPPD without DJ-colon pexy (No DJ-pexy group) was performed in 39 patients, and 39 patients underwent PPPD with DJ-colon pexy (DJ-pexy group). A comparative analysis between the two groups showed no differences in age, sex, diagnosis, operation time, hospital stay, or postoperative complications, including pancreatic fistula (p > 0.05). Overall, DGE developed in seven patients (17.9%) in the No DJ-pexy group and in 10 patients (25.6%) in the DJ-pexy group (p = 0.411). The clinically relevant DGE (grades B and C) was also similar between two groups (12.8% vs. 17.9%, p = 0.530). The day that patients could eat more than half of the solid oral intake amount was marginally earlier in the Braun group (8.7 vs. 12.4 days, p = 0.054). The incidence and severity of DGE did not differ between DJ-pexy and No DJ-pexy group after PPPD.

Autonomic cardiogastric neural interaction after pulmonary vein isolation in patients with atrial fibrillation.

Clinical significance of reduced vagal activity following pulmonary vein isolation (PVI) for atrial fibrillation (AF) remains unclear. Periesophageal vagal nerve injury following PVI may be a powerful contributing factor of decreased vagal tone. Drug-refractory 51 AF patients (31 males, 64 ± 11years), who underwent successful PVI, were enrolled. We performed esophagogastroduodenoscopy 2days after PVI and assessed delayed gastric emptying (DGE). Additionally, the coefficient of variance of R-R interval (CVRR) as a surrogate for vagal tone was measured before PVI, as well as at 1day and 3months after PVI. The patients were divided into two groups, patients with DGE and patients without DGE, and changes in CVRR were compared. After PVI, 12 out of 51 patients (23.5%) had DGE. The baseline CVRR did not differ between the patients with (n = 12) and those without (n = 39) DGE (median 3.13%, interquartile range 1.69-5.13 vs. median 3.76%, interquartile range 2.96-5.90, P = 0.297). However, CVRR at 1day after PVI was significantly lower in the patients with DGE than in those without (median 1.49%, interquartile range 0.90-2.19 vs. median 2.59%, interquartile range 1.58-3.86, P = 0.035), and then CVRR at 3months became similar between the two groups, suggesting that the two groups had different changes in vagal tone after PVI. The recurrence of AF was similar at 3-6months after PVI between the two groups. A significantly decreased CVRR immediately after PVI is a sign of DGE incidence, implying collateral damage to the esophagus.

Differential gastric emptiness according to preoperative stomach position in neurological impaired patients who underwent laparoscopic fundoplication and gastrostomy.

We sometimes experienced prolonged delayed gastric emptying (DGE) in neurologically impaired patients undergoing laparoscopic fundoplication and gastrostomy. We explored the difference in the DGE rate according to the preoperative stomach position. Thirty-two neurological impaired patients who underwent laparoscopic fundoplication and gastrostomy between 2015 and 2019 were classified into two groups based on stomach position: non-elevated stomach position (NESP) and elevated stomach position (ESP). Patients' characteristics, operative result and postoperative gastric emptying were reviewed. The 11 ESP patients were significantly older than the 21 NESP patients (p < 0.05). The ESP patients had a significantly heavier body weight (BW) than the NESP patients (p < 0.05). The time taken (days) to reduce gastric drainage (days, below BW × 10ml) in the NESP (4.3 ± 3.6) was significantly longer than that of ESP (1.3 ± 1.6) (p < 0.05). The time taken (days) to achieve full enteral nutrition in the NESP (14.1 ± 8.9) was significantly longer than that of the ESP patients (8.8 ± 3.1) (p < 0.05). Elevated stomach position (ESP) patients archived full enteral nutrition earlier than NESP patients after laparoscopic fundoplication and gastrostomy. Stomach position correction might, therefore, be involved in the incidence of DGE.

Prevention of delayed gastric emptying after living donor left hepatectomy

Delayed gastric emptying (DGE) is uncomfortable complication after left hepatectomy. The aim of this study is to show our strategy to prevent DGE after living donor left hepatectomy. The cases were divided into 3 groups as without any prevention (control group), prevented DGE with putting omentum between the liver and pylorus (O group), and with putting a Seprafilm (S group). The incidence of DGE and the CT finding 1 month after surgery were retrospectively compared between the groups. The incidence of DGE was significantly decreased in O and S group than control group (P<0.05, Fisher's test). In S group, fluid collection along the cutting surface of the liver was observed on CT significantly more than other groups, but the incidence of bile leakage was adversely less in S groups than other groups, meaning that collected fluid in S group were presumed as the ascites without bile. Omentum patching and Seprafilm were equally effective to prevent DGE after living donor left hepatectomy, and Seprafilm might be better because it is more physiologic.

Does Pyloric-ring Resection in Pancreaticoduodenectomy Prevent Delayed Gastric Emptying?

Objective: Delayed gastric emptying (DGE) is a common, post pancreaticoduodenectomy (PD) complication, which prolongs hospital stay, increases the cost of treatment and delays adjuvant therapy. Although, pylorospasm is one of the proposed mechanisms, the results of pyloric ring resection PD remain controversial. Hence, this study investigated whether pyloric ring resection PD decreased the incidence of DGE.Material and Methods: Between June, 2015 and July, 2018; 74 patients underwent a PD for periampullary lesions, of whom 25 patients received pylorus-preserving PD (PPPD) and 49 patients received pyloric-ring resection PD (PRPD). DGE was classified according to the International Study Group of Pancreatic Surgery.Results: The incidence of DGE in the PPPD group and PRPD group were 48.0% (12 of 25 patients) and 20.4% (10 of 49 patients), respectively (p-value=0.029). Factors associated with DGE were pyloric preserving [adjusted Odds ratio (OR)=8.26, 95% confidence interval (CI): 1.96-34.82, p-value=0.002], preoperative biliary drainage (adjusted OR=0.19, 95% Cl: 0.05-0.78, p-value=0.013) and postoperative intraabdominal collection (adjusted OR=37, 95% Cl: 5.68-241.24, p-value&lt;0.001).Conclusion: PRPD demonstrated a significant decrease of DGE, and should be one of the standard surgical treatments for periampullary carcinoma.

Gastrocolic ligament lymph-node dissection may increase the incidence of delayed gastric emptying after colon cancer surgery with D3 lymphadenectomy.

Delayed gastric emptying (DGE) is associated with prolonged hospital stay and higher healthcare costs. This study aimed to investigate the risk factors for DGE after D3 radical resection for colon cancer and to build a nomogram for this complication. We analyzed, retrospectively, 1160 consecutive patients who underwent surgery with D3 lymphadenectomy for colon cancer between January, 2012 and June, 2018. A multivariate logistic regression analysis was used to identify the risk factors for DGE and to build a DGE nomogram model. There were ten, six and four patients with DGE classified as grades A, B and C, respectively, representing a DGE rate of 1.7%. Multivariate analysis revealed that age (P = 0.001), dissection of the gastrocolic ligament lymph nodes (GCLNs) (P = 0.001), surgical duration (P = 0.017) and preoperative hemoglobin level (P = 0.016) were independent risk factors, and were included to build a predictive model for DGE. The therapeutic index of GCLN dissection was approximately half that of D3 lymphadenectomy (2.9 vs. 5.6). DGE is more likely to develop in patients aged > 75years, those with a preoperative hemoglobin < 90g/L, those with a surgical duration > 210min, and those who undergo GCLN dissection. The nomogram may facilitate the stratification of patients at risk for DGE following D3 lymphadenectomy for colon cancer. Assessing long-term outcomes will help to evaluate the survival benefit of GCLN dissection in the future, to avoid unnecessary dissection and reduce the incidence of DGE.

Delayed gastric emptying after subtotal stomach-preserving pancreatoduodenectomy: pancreatogastrostomy vs pancreatojejunostomy

Objective The relation between type of pancreatic remnant reconstruction and delayed gastric emptying (DGE) following pancreatoduodenectomy (PD) is unclear. The authors are trying to detect the incidence of DGE following PD and its relation to both types of pancreatic remnant anastomosis, pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ). Patient and methods This retrospective study included 44 patients who underwent PD. These patients were classified according to the type of pancreatic anastomosis into two groups: PG group and PJ group. The development of DGE and its combination with intra-abdominal complications (IACs) was compared between both groups. Risk factors responsible for clinically evident DGE were analyzed. Results The incidence of GDE in both PG and PJ was 27.3%. DGE was strongly associated with IACs, particularly pancreatic fistula. Furthermore, DGE occurred more commonly with PG than PJ. Although IACs developed at a similar rate in both types of pancreatic reconstruction, DGE in combination with IACs was more frequent with PG. Durations of both nasogastric tube and solid diet tolerance were prolonged in DGE patients in comparison with non-DGE patients. Moreover, prokinetic use, nasogastric tube reinsertion, and vomiting were more frequent in DGE patients than non-DGE patients. Conclusion DGE was strongly associated IACs. Regarding the type of pancreatic reconstruction, DGE is more common with PG than PJ. This may be because IACs developed more frequently with PG, resulting in more frequent development of DGE.

Impact of Gastric Resection and Enteric Anastomotic Configuration on Delayed Gastric Emptying after Pancreaticoduodenectomy: A Network Meta-analysis of Randomized Trials

Purpose: Delayed gastric emptying (DGE) is frequent after pancreaticoduodenectomy (PD). Several randomised controlled trials (RCTs) have explored operative strategies to minimise DGE, however, the optimal combination of gastric resection approach, anastomotic route, and configuration, role of Braun enteroenterostomy remains unclear. Methods: MEDLINE, Embase, and CENTRAL databases were systematically searched for RCTs comparing gastric resection (Classic Whipple, pylorus-resecting, and pylorus-preserving), anastomotic route (antecolic vs retrocolic) and configuration (Billroth II vs Roux-en-Y), and enteroenterostomy (Braun vs no Braun). A random-effects Bayesian network meta-analysis was conducted to determine the optimal combination of approaches to PD for minimising DGE. Results: Twenty-four RCTs, including 2526 patients and 14 approaches were included. There was some heterogeneity, although inconsistency was low. The overall incidence of DGE was 25.6% (n = 647). Pylorus-resecting, antecolic, Billroth II with Braun was associated with the lowest rates of DGE and ranked the best in 35% of comparisons. Classic Whipple, retrocolic, Billroth II with Braun ranked the worst for DGE in 32% of comparisons. Pairwise meta-analysis of retrocolic vs antecolic route of gastro-jejunostomy found increased risk of DGE with the retrocolic route (OR 2.1, 95% CrI; 0.92 - 4.7). Pairwise meta-analysis of Braun found a trend towards lower DGE rates with Braun compared to no Braun (OR 1.9, 95% CrI; 0.92 - 3.9). Having a Braun ranked the best in 96% of comparisons. Conclusion: Based on existing RCT evidence, a pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy may be associated with the lowest rates of DGE.

Preventing Delayed Gastric Emptying after Whipple'S Procedure - Isolated Roux Loop Reconstruction with Pancreatico-Gastrostomy

Introduction: Although delayed gastric emptying (DGE) after Whipple's pancreaticoduodenectomy is not life threatening and can be treated conservatively, it results in discomfort and significant prolongation of the hospital stay and adds on to the hospital costs. To overcome this problem, we started using the isolated loop technique of reconstruction along with pancreaticogastrostomy and we present our series using this technique. Methods: All consecutive patients undergoing Whipple's pancreaticoduodenectomy in a single surgical unit from January 2009 until December 2018 were included. In the absence of hepatic and peritoneal metastasis, resection (Whipple's procedure) with curative intent was done using isolated loop technique with pancreaticogastrostomy. Delayed gastric emptying was assessed clinically and on oral gastrograffin study. Bile reflux was also assessed on clinical parameters and evidence of beefy friable gastric mucosa on upper GI endoscopy and presence of reflux on hepatobiliary scintigraphy. Results: A total of 101 patients were operated using this technique from January 2009 to December 2018. The mean operative time was 260.8 ± 50.3, and the mean operative blood loss was 1,068.0 ± 606.1 ml. Mean gastric emptying time 106.0 ± 6.1 min (89-258 min). 5 out of the 101 (4.9 %) patients had persistent vomiting in the post-operative period requiring reinsertion of NG tube. A HIDA scan done on POD7 for all patients did not show any evidence of bile reflux in any of the patients. Conclusion: Pancreatogastrostomy with isolated loop in pancreaticoduodenal resection markedly reduces the post-operative incidence of alkaline reflux gastritis and DGE

Delayed Gastric Emptying in Diabetic Patients Undergoing Pancreaticoduodenctomy: A Procedure-targeted NSQIP Analysis

Introduction: Delayed gastric emptying (DGE) is a major source of morbidity after pancreaticoduodenctomy (PD). Patients with diabetes mellitus (DM) have a propensity for gastric dysmotility, however the relationship between DGE and DM is not clearly established. The aim of this study was to determine the incidence of DGE in patients with and without DM after PD.

Roux-en-Y and Billroth II Reconstruction after Pancreaticoduodenectomy: A Meta-Analysis of Complications.

Objective To evaluate Roux-en-Y and Billroth II reconstruction following pancreaticoduodenectomy (PD). Methods PubMed, Embase, the Cochrane Library, and the Web of Science were searched to identify randomized controlled trials (RCTs) and controlled clinical trials that compared Roux-en-Y and Billroth II reconstruction following PD up to December 2019. RevMan 5.3 software was used for the statistical analysis. Results Four RCTs and five controlled clinical trials were included, with a total of 1,072 patients (500 and 572 patients in the Roux-en-Y and Billroth II groups, respectively). No significant differences in delayed gastric emptying (DGE), A-grade DGE, B-grade DGE, or C-grade DGE were observed between the Roux-en-Y and Billroth II reconstruction groups after PD (odds ratio [OR] = 1.01, 95% confidence interval [CI]: 0.50–2.03, P = 0.98; OR = 0.49, 95% CI: 0.17–1.45, P = 0.20; OR = 0.63, 95% CI: 0.29–1.38, P = 0.25; and OR = 2.13, 95% CI: 0.38–11.99, P = 0.39). No significant difference in the incidence of postoperative pancreatic fistula, abscess, bile leaks, infection, postoperative bleeding, or the length of the postoperative hospital stay was observed between the Roux-en-Y and Billroth II groups (P > 0.05), but the operation time was significantly different (mean difference [MD] = 31.65, 95% CI: 7.14–56.17, P = 0.01). Conclusions Billroth II reconstruction after PD did not significantly reduce the incidence of DGE or other complications but shortened the operation time compared to Roux-en-Y reconstruction. However, the results must be verified by further high-quality, large RCTs or controlled clinical trials.

Delayed Gastric Emptying Post-Esophagectomy: A Single-Institution Experience.

Delayed gastric emptying (DGE) is a common functional disorder after esophagectomy in patients with esophageal carcinoma. Management of DGE varies widely and it is unclear how comorbidities influence the postoperative course. This study sought to determine factors that influence postoperative DGE. This retrospective study evaluates patients who underwent esophagectomy with gastric pull-up between 2007 and 2019. The cohort was stratified in various ways to determine if postoperative care and outcomes differed, including patient demographics, comorbidities, intraoperative and postoperative procedures. During the study period, 149 patients underwent esophagectomy and 37 had diabetes. Overall incidence of DGE, as defined in this study, was 76.5%. Surgery type was significantly different between DGE and normal emptying cohorts (P = 0.005). Comparing diabetic and nondiabetic patients, there was no significant difference noted in DGE (P = 0.25). Additionally, there was no difference in presence of DGE for patients who underwent any intraoperative pyloric procedure compared to those who did not (P = 0.36). Of significance, all 16 patients with chronic obstructive pulmonary disease had a delay in gastric emptying (P = 0.01). A higher proportion of patients with DGE post-esophagectomy were identified compared to the literature. There is little consensus on a true definition of DGE, but we believe this definition identifies patients suffering in the immediate postoperative period and in follow-up. There is no evidence to support a different postoperative course for patients with diabetes, but the link between chronic obstructive pulmonary disease and DGE warrants further investigation.