Enteral Nutrition and Biliopancreatic Diversion Effectively Minimize Impacts of Gastroparesis After Pancreaticoduodenectomy

Abstract

Modified procedure does not reduce the risk of gastroparesis but appears to reduce the severity when it occurs.

Effect of Nasogastric Tube Feeding vs Nil per Os on Dysmotility in Acute Pancreatitis

“…Physiological reasons include promotion of gut motility through feeding and feedback stimulation of brain centers associated with eating and appetite. 29 – 31 The importance of the latter in patients with AP was suggested in a recent randomized trial that showed that the timing to initiate oral refeeding may be best determined based on hunger 32 . Psychological reasons emphasize the emerging concept of patient‐centeredness and the need to assess patient‐reported outcomes to better determine health‐related quality of life 33 , 34 …”

Reflux Esophagitis and Marginal Ulcer After Pancreaticoduodenectomy

“…Uncut Roux-en-Y digestive tract reconstruction was performed as described previously. 15 Briefly, in patients with Roux-en-Y digestive tract reconstruction, a section 45 cm from the stomach or duodenum, along the efferent limb, was raised to the afferent limb, creating a side-to-side jejunojejunostomy. A TA 30-3.5 stapler (Ethicon, Cornelia, GA, USA) was used to close the afferent limb just proximal to its entrance into the stomach or duodenum.…”

“…A TA 30-3.5 stapler (Ethicon, Cornelia, GA, USA) was used to close the afferent limb just proximal to its entrance into the stomach or duodenum. 15 Standard PD with hemigastrectomy was performed in 158 patients. The hemigastrectomy line was determined by selecting a point on the greater curvature where the left gastroepiploic artery most nearly approximated the greater curvature wall.…”

“…9,10 In addition, several papers have reported that delayed gastric emptying (DGE) developed significantly more often after PPPD than after standard PD. [11][12][13] Some authors have reported the use of Roux-en-Y gastrointestinal reconstruction (R-Y) after PD to prevent DGE; 14,15 however, an R-Y reconstruction after PPPD has been reported to be associated with a high incidence of marginal ulcer. 16 Reflux esophagitis is a common complication following distal gastrectomy.…”

Meta-analysis of effect of routine enteral nutrition on postoperative outcomes after pancreatoduodenectomy

“…All studies were graded as high risk for performance bias (blinding of participants) because the nutrition route was apparent to the clinical staff. In five studies 20,23,[25][26][27] attrition bias (incomplete outcome data) was reduced by the performance of intention-to-treat analyses. Table 3 summarizes the statistical findings of meta-analyses comparing enteral nutrition with non-enteral nutrition, enteral nutrition with parenteral nutrition, enteral feeding using a percutaneous tube with parenteral nutrition, and enteral feeding using a nasojejunal tube with parenteral nutrition.…”