Enteral nutrition and biliopancreatic diversion effectively minimize impacts of gastroparesis after pancreaticoduodenectomy.

Abstract

BACKGROUND:

Since gastroparesis is unavoidable in a certain proportion of patients after pancreaticoduodenectomy, measures to avoid its occurrence or at least minimize its impact are needed. A prospective randomized trial was performed to test the effectiveness of biliopancreatic diversion with modified Roux-en-Y gastrojejunostomy reconstruction and of enteral feeding to minimize impacts of gastroparesis after pancreaticoduodenectomy.

METHODS:

In total, 247 patients with periampullary tumors were randomized at the time of pancreaticoduodenectomy to have either (1) modified Roux-en-Y gastrojejunostomy reconstruction (by creating a side-to-side jejunojejunostomy between afferent and efferent loop and closing the afferent loop with a TA-30-3.5 stapler) and insertion of a jejunostomy feeding tube (modified group) or (2) conventional gastric bypass (control group). Outcomes including complications, duration of nasogastric tube placement, and length of hospital stay were followed prospectively.

RESULTS:

Gastroparesis occurred in 20 patients (16.3%) in the modified group and 27 patients in the control group (21.7%, P = 0.27). However, the International Study Group of Pancreatic Surgery grades of gastroparesis were significantly lower in the modified group (10A, 5B, 5C) than in the control group (4A, 5B, 18C, P = 0.01).

CONCLUSIONS:

Modified procedure does not reduce the risk of gastroparesis but appears to reduce the severity when it occurs.

• Authors: Yu-Wen Tien, Ching-Yao Yang, Yao-Ming Wu, Rey-Heng Hu, Po-Huang Lee
• Journal: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (J Gastrointest Surg) Vol. 13 Issue 5 Pg. 929-37 (May 2009) ISSN: 1873-4626 [Electronic] United States
• PMID: 19224292 (Publication Type: Journal Article, Randomized Controlled Trial)

Topics

• Adult
• Aged
• Biliopancreatic Diversion (methods)
• Cohort Studies
• Duodenostomy
• Enteral Nutrition (methods)
• Female
• Gastric Bypass
• Gastroparesis (etiology, prevention & control)
• Humans
• Jejunostomy
• Length of Stay
• Male
• Middle Aged
• Pancreatic Diseases (pathology, surgery)
• Pancreaticoduodenectomy (adverse effects)
• Treatment Outcome