title: Enteral nutrition reduces delayed gastric emptying after standard pancreaticoduodenectomy with child reconstruction.
abstract: BACKGROUND
  Delayed gastric emptying (DGE) is a common complication following pancreaticoduodenectomy (PD). Our retrospective study aimed to evaluate the influence of enteral nutrition (EN) on DGE incidence after standard PD with antrectomy and Child reconstruction.
  
  
  METHODS
  We retrospectively analyzed 275 consecutive patients who underwent standard PD between January 2000 and September 2009. Patients operated on after January 2005 received EN (EN group, n = 152) until total oral alimentation. Patients operated on prior to 2005 did not receive EN (control group, n = 123) and were orally fed after removing the nasogastric tube. Primary endpoint was the incidence of DGE according to the International Study Group of Pancreatic Surgery criteria. Secondary endpoints were the incidence of any other complications.
  
  
  RESULTS
  The incidence of DGE was 26% vs. 38% (p = 0.04) in the EN and control groups, respectively, with 17% vs. 19% for grade B DGE (NS) and 9% vs. 19% for grade C DGE (p = 0.02). The differences in DGE did not significantly decrease the duration of stay (18 ± 11 vs. 19 ± 13 days; NS). Postpancreatectomy hemorrhage was significantly reduced in the EN group (8% vs. 20%, p = 0.008), with the incidence of postoperative pancreatic fistula being similar in both groups (15% vs. 12%; NS). Using multivariate analysis, EN (p = 0.047, OR = 0.559 [0.315; 0.994]), operative time (p < 0.001, OR = 1.007 [1.003; 1.010]), and patient age (p = 0.014, OR = 1.031 [1.006; 1.057]) were independent factors affecting the incidence of DGE.
  
  
  CONCLUSIONS
  EN reduces DGE and postpancreatectomy hemorrhage after PD.
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Université de Rennes 1, Rennes, France. michel.rayar@laposte.net
authors.forename: Michel
authors.initials: M
authors.lastname: Rayar
authors.forename: Laurent
authors.initials: L
authors.lastname: Sulpice
authors.forename: Bernard
authors.initials: B
authors.lastname: Meunier
authors.forename: Karim
authors.initials: K
authors.lastname: Boudjema
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D005746:Gastric Emptying; D018589:Gastroparesis / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control; D011706:Pyloric Antrum / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome