Delayed gastric emptying (DGE) after pancreatic surgery: A suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)

Wente, Moritz N.; Bassi, Claudio; Dervenis, Christos; Fingerhut, Abe; Gouma, Dirk J.; Izbicki, Jakob R.; Neoptolemos, John P.; Padbury, Robert; Sarr, Michael G.; Traverso, L. William; Yeo, Charles J.; Büchler, Markus W.

doi:10.1016/j.surg.2007.05.005

Cited by 2,354 publications

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“…Pancreatic fistula was defined and graded according to the International Study Group on Pancreatic Surgery (ISGPS) 2016 criteria,19 and grades B and C were defined as clinically relevant pancreatic fistula. Delayed gastric emptying (DGE) was defined according to a consensus definition and clinical grading of postoperative DGE proposed by the ISGPS, and DGE was classified into grades A, B, or C, based on the clinical course and postoperative management 20. Postoperative hospital stay was defined as the duration from the date of operation to the date of discharge.…”

Section: Methodsmentioning

confidence: 99%

Mesenteric approach during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Hirono

Kawai

Okada

et al. 2017

Annals of Gastroent Surgery

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Mesenteric approach is an artery‐first approach during pancreaticoduodenectomy (PD). In the present study, we evaluated clinical and oncological benefits of this procedure for pancreatic ductal adenocarcinoma (PDAC) of the pancreas head. Between 2000 and 2015, 237 consecutive PDAC patients underwent PD. Among them, 72 experienced the mesenteric approach (mesenteric group) and 165 the conventional approach (conventional group). A matched‐pairs group consisted of 116 patients (58 patients in each group) matched for age, gender, resectability status, and neoadjuvant therapy. Surgical and oncological outcomes were compared between the two groups in unmatched‐ and matched‐pair analyses. Intraoperative blood loss was lower in the mesenteric group than in the conventional group in both resectable PDAC (R‐PDAC) and borderline resectable PDAC (BR‐PDAC) on unmatched‐ and matched‐pairs analyses (R‐PDAC, unmatched: 312.5 vs 510 mL, P=.008; matched: 312.5 vs 501.5 mL, P=.023; BR‐PDAC, unmatched: 507.5 vs 935 mL, P<.001; matched: 507.5 vs 920 mL, P=.003). Negative surgical margins (R0) and overall survival (OS) rates in the mesenteric group were better in R‐PDAC patients (R0 rates, unmatched: 100% vs 87.7%, P=.044; matched: 100% vs 86.7%, P=.045; OS, unmatched: P=.008, matched: P=.021), although there were no significant differences in BR‐PDAC patients. Mesenteric approach might reduce blood loss by early ligation of the vessels to the pancreatic head. Furthermore, it might increase R0 rate, leading to improvement of survival for R‐PDAC patients. However, R0 and survival rates could not be improved only by the mesenteric approach for BR‐PDAC patients. Therefore, effective multidisciplinary treatment is essential to improve survival in BR‐PDAC patients.

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Section: Methodsmentioning

confidence: 99%

Mesenteric approach during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Hirono

Kawai

Okada

et al. 2017

Annals of Gastroent Surgery

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“…DGE was assessed based on the 2007 International Study Group of Pancreatic Surgery (ISGPS) definition and grading. 11 POPF was assessed based on 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula. 12,13 Wound infection was defined as infection less than 30 days after surgery involving skin, subcutaneous tissue, deep soft tissues (fascia and muscle) plus one of following purulent discharge, diagnosis of infection by pus for culture and sensitivity and symptoms of local pain, erythema, oedema, and fever.…”

Section: Methodsmentioning

confidence: 99%

Addition of Braun enteroenterostomy to standard reconstruction in pancreaticoduodenectomy: impact on early outcomes

et al. 2017

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INTRODUCTIONPancreaticoduodenectomy (Whipple procedure) is the standard treatment for operable carcinomas of the head of the pancreas, periampullary tumors and in some cases of chronic pancreatitis. Advances in surgical skills and postoperative care have resulted in mortality rates of less than 5%.1 Despite significant improvements in the safety and efficacy of pancreatic surgery, morbidity still remains high in the range of 30% to 65%.2 Delayed gastric emptying (DGE) and Postoperative Pancreatic fistula (POPF) remains the major causes of morbidity.The exact cause of DGE following pancreaticoduodenectomy is not known. It appears to be multifactorial. [3][4][5] Technical factors in the construction of gastroenterostomy have been implicated in the development of DGE. Significant edema or kinking at this anastomosis may be a factor in the development of DGE. 6 ABSTRACT Background: Morbidity following Pancreaticoduodenectomy still remains high. Few studies have shown decrease in morbidity with the addition of Braun Enteroenterostomy (BEE). Aim of the present study was to determine any possible benefit with addition of BE to the standard reconstruction after pancreaticoduodenectomy. Methods: In this prospective randomized controlled study, all patients who underwent Pancreaticoduodenectomy from June 2012 to July 2016 were included. They were randomized to undergo either standard reconstruction (Group A) or with addition of Braun Enteroenterostomy to standard reconstruction (Group B). Outcomes were compared between 2 groups and the results were analyzed. P value of <0.05 was considered significant. Results: 104 patients were included in the study. Group A included 56 patients who underwent standard reconstruction and Group B had 48 patients who had addition of BEE to standard reconstruction. The demographic profile, tumour characteristics, and biochemical profile were similar in 2 groups. Mean operating time and Intra operative blood loss were similar. The incidence of pancreatic fistula (POPF) did not differ significantly in 2 groups (14/56, 25% in group A versus 8/48, 16.6% in group B; p = 0.42). The incidence of Delayed Gastric Emptying (DGE) was not statistically different in 2 groups (20/56, 35.7% in group A versus 12/48, 25% in group B; p=0.77). Infection rates were similar in two groups. Mean hospital stay was similar in both groups (11.2 days versus 10.7 days; p=0.68). Conclusions:The outcomes of patients after pancreaticoduodenectomy were not altered by addition of Braun Enteroenterostomy to standard reconstruction.

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“…Delayed gastric emptying was classified largely according to the scoring system launched by the International Study Group on Pancreatic Surgery [33]. The postoperative complications were scored according to Clavien-Dindo [34].…”

Section: Methodsmentioning

confidence: 99%

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2017

Endosc Int Open

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Delayed gastric emptying (DGE) after pancreatic surgery: A suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)

Cited by 2,354 publications

References 69 publications

Mesenteric approach during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Mesenteric approach during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Addition of Braun enteroenterostomy to standard reconstruction in pancreaticoduodenectomy: impact on early outcomes

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