Enteral nutrition and biliopancreatic diversion effectively minimize impacts of gastroparesis after pancreaticoduodenectomy.
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.
Tien
Yu-Wen
YW
Department of Surgery, College of Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan, Republic of China. ywtien5106@ntu.edu.tw
Yang
Ching-Yao
CY
Wu
Yao-Ming
YM
Hu
Rey-Heng
RH
Lee
Po-Huang
PH
D000328:Adult; D000368:Aged; D015904:Biliopancreatic Diversion / Q000379:methods*; D015331:Cohort Studies; D004385:Duodenostomy; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D015390:Gastric Bypass; D018589:Gastroparesis / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D007582:Jejunostomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D016896:Treatment Outcome