85.1) patients in the NJEEN group versus 64.4% (95% CI 54.2-73.6) in TPN group (p = 0.040). NJEEN was associated with higher frequency of postoperative pancreatic fistula (48.1% vs 27.7%, p = 0.012) and higher severity (grade B/C 29.4% vs 13.9%; P = 0.007). There was no significant difference in the incidence of post-pancreatectomy hemorrhage, delayed gastric emptying, infectious complications, the grade of postoperative complications, and the length of postoperative stay. A successful NJEEN was achieved in 63% patients. Conclusion: In patients undergoing PD, NJEEN was associated with an increased overall postoperative complications rate. The frequency and the severity of POPF were also significantly increased after NJEEN. In terms of safety and feasibility, NJEEN should not be recommended.
Background: Pancreatoduodenectomy (PD) is the recommended procedure for malignant and high-risk premalignant lesions in the pancreatic head and the periampullary region. Although it is associated with low mortality rates, the risk of new-onset pancreatogenic diabetes mellitus (NOPDM) is a chronic complication with substantial and long-lasting effects on quality of life. We aimed to assess the risk of NOPDM after PD. Methods: PubMed, Cochrane, and Embase databases were searched for cohort studies and randomized controlled trials published before May 2016, including patients after PD. Primary endpoint was the risk of NOPDM in (pre)malignant disease and a subgroup analysis of the risk for insulin dependent NOPDM and separately the risk in malignant and premalignant disease was performed. Mean weighted overall proportions of NOPDM after PD were calculated with 95% confidence intervals (CI). Results: After screening 1,381 studies, 25 studies, representing 1,252 patients, were included. Mean follow-up of patients was 3.7 years (AE1.7). The mean weighted overall proportion of NOPDM after PD was 19%, (95% CI = 16-22). Of all patients, 13%, (95% CI = 10-16), developed insulin dependent NOPDM after PD. The incidence of NOPDM after PD for malignant disease was 21%, (95% CI = 16-27), was similar to 32% (95% CI = 23-41) for premalignant disease (P = 0.12). Conclusion: About 20% of patients develop diabetes after PD for malignant and premalignant disease. Preoperative counseling should include NOPDM risk and the related symptoms.
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