title: Clinical risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: a systematic review and meta-analysis.
abstract: BACKGROUND
  The clinical risk factors of delayed gastric emptying (DGE) in patients after pancreaticoduodenectomy (PD) remains controversial. Herein, we conducted a systematic review to quantify the associations between clinical risk factors and DGE in patients after conventional PD or pylorus preserving pancreaticoduodenectomy (PPPD).
  
  
  METHODS
  A systematic search of electronic databases (PubMed, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1970 to 2012 was performed. Cohort, case-control studies, and randomized controlled trials that examined clinical risk factors of DGE were included.
  
  
  RESULTS
  Eighteen studies met final inclusion criteria (total n = 3579). From the pooled analyses, preoperative diabetes (OR 1.49, 95% CI, 1.03-2.17), pancreatic fistulas (OR 2.66, 95% CI, 1.65-4.28), and postoperative complications (OR 4.71, 95% CI, 2.61-8.50) were significantly associated with increased risk of DGE; while patients with preoperative biliary drainage (OR 0.68, 95% CI, 0.48-0.97) and antecolic reconstruction (OR 0.17, 95% CI, 0.07-0.41) had decreased risk of DGE development. Gender, malignant pathology, preoperative jaundice, intra-operative transfusion, PD vs. PPPD and early enteral feeding were not significantly associated with DGE development (all P > 0.05).
  
  
  CONCLUSIONS
  Our findings demonstrate that preoperative diabetes, pancreatic fistulas, and postoperative complications were clinical risk factors predictive for DGE. Antecolic reconstruction and preoperative biliary drainage result in a reduction in DGE. Knowledge of these risk factors may assist in identification and appropriate referral of patients at risk of DGE.
authors.affiliation: Department of General Surgery, Shandong University Qilu Hospital, No. 107 of the West Cultural Road, Jinan 250012, Shandong, China.
authors.forename: H
authors.initials: H
authors.lastname: Qu
authors.forename: G R
authors.initials: GR
authors.lastname: Sun
authors.forename: S Q
authors.initials: SQ
authors.lastname: Zhou
authors.forename: Q S
authors.initials: QS
authors.lastname: He
mesh_terms: D016022:Case-Control Studies; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D048909:Diabetes Complications / Q000175:diagnosis; D005260:Female; D005746:Gastric Emptying; D018589:Gastroparesis / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010185:Pancreatic Fistula / Q000150:complications*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D057234:Preoperative Period; D011708:Pylorus / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013396:Suction; D016896:Treatment Outcome