Delayed Gastric Emptying and Gastric Remnant Function After Pancreaticoduodenectomy: A Systematic Review of Objective Assessment Modalities

Abstract

Background Delayed gastric emptying (DGE) is a frequent complication after pancreaticoduodenectomy (PD). The diagnosis of DGE is based on International Study Group for Pancreatic Surgery (ISGPS) clinical criteria and objective assessments of DGE are infrequently used. The present literature review aimed to identify objective measures of DGE following PD and determine whether these measures correlate with the clinical definition of DGE. Methods A systematic search was performed using the MEDLINE Ovid, EMBASE, Google Scholar and CINAHL databases for studies including pancreatic surgery, delayed gastric emptying and gastric motility until June 2022. The primary outcome was modalities undertaken for the objective measurement of DGE following PD and correlation between objective measurements and clinical diagnosis of DGE. Relevant risk of bias analysis was performed. Results The search revealed 4881 records, of which 46 studies were included in the final analysis. There were four objective modalities of DGE assessment including gastric scintigraphy (n = 28), acetaminophen/paracetamol absorption test (n = 10), fluoroscopy (n = 6) and the 13C-acetate breath test (n = 3). Protocols were inconsistent, and reported correlations between clinical and objective measures of DGE were variable; however, amongst these measures, at least one study directly or indirectly inferred a correlation, with the greatest evidence accumulated for gastric scintigraphy. Conclusion Several objective modalities to assess DGE following PD have been identified and evaluated, however are infrequently used. Substantial variability exists in the literature regarding indications and interpretation of these tests, and there is a need for a real-time objective modality which correlates with ISGPS DGE definition after PD.

Evaluation of gastric electrophysiology, symptoms and quality of life after pancreaticoduodenectomy

“…While the Gastric Alimetry spectral analyses did not resolve symptom causation in this cohort studied in the years after PD, gastric emptying status was not assessed. Further research is therefore now needed to assess whether changes in gastric electrophysiology might occur earlier in the post-operative course, as previously found with legacy electrogastrography techniques (3, 6), which could plausibly resolve a contributing factor to the specific complication of DGE (31).…”

“…Post-operative complications are common, including pancreatic fistula and delayed gastric emptying (DGE), which ranges between 10 to 45%, along with non-specific symptoms of nausea, vomiting and abdominal pain, which impairs quality of life (QoL) and prolongs hospitalisation, as well as increasing healthcare costs (1)(2)(3)(4). While there have been several operative attempts at reducing the incidence of DGE (antecolic vs retrocolic, pyloruspreserving vs pylorus-resecting), the underlying pathophysiology is still to be determined.…”

Prevention of delayed gastric emptying after right colectomy with extended lymphadenectomy: A randomized controlled trial

“…[ 3 , 20 ] DGE has been intensively studied after pancreatic surgery, proving its existence and its disadvantages: can prolong ICU and postoperative hospitalization, but there are few studies about DGE after right colectomy and no study on how we can prevent it. [ 8 , 21 , 22 ] Lymph node dissection of the gastrocolic ligament in patients with advanced proximal transverse colon cancer may favor the existence of DGE, the percentage varies between 1.7% and 14%. [ 3 , 20 ] The existence of DGE after proximal transverse colon cancer surgery is known in the literature, some authors have tried to identify a nomogram in order to facilitate the stratification of patients at risk for DGE following D3 lymphadenectomy; Deng Y et al [ 8 ] in their study, identified that: age, dissection of GCLN, surgical duration and preoperative hemoglobin level were independent risk factors for DGE.…”

Preoperative and postoperative complications as risk factors for delayed gastric emptying following pancreaticoduodenectomy: A single-center retrospective study

“…With medico-technological advancements, PD has become a standardized surgical approach for treating pancreatic head cancer and periampullary benign and malignant tumors[ 2 ], decreasing serious postoperative complications such as severe pancreatic leakage, bile leakage, and massive hemorrhage[ 3 ]. However, the underlying mechanism of delayed gastric emptying (DGE), one of its complications, remains unknown, presenting a challenge for clinicians in its treatment[ 4 ]. Despite advancements in surgical techniques and perioperative management, which have reduced the occurrence of severe postoperative complications such as severe pancreatic leakage, bile leakage, and massive hemorrhage, some complications, particularly DGE, continue to be prevalent among those who underwent PD, with no known cause or effective treatment[ 5 ].…”