Is systematic nasogastric decompression after pancreaticoduodenectomy really necessary?

Gaignard, Elodie; Bergeat, Damien; Courtin-Tanguy, Laetitia; Rayar, Michel; Merdrignac, Aude; Robin, Fabien; Boudjéma, Karim; Beloeil, Hélène; Meunier, Brigitte; Sulpice, Laurent

doi:10.1007/s00423-018-1688-8

Cited by 22 publications

(35 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, one study was excluded because some patients in the NGD group underwent nasogastric tube insertion (NGT) [20]. Finally, six studies were included in the systematic review and meta-analysis [5,15,16,[21][22][23]. The final analysis included a total 940 patients, with 484 patients in the RGD group, and 456 patients in the NGD group.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies reported on postoperative complications [15,16,[21][22][23]. Overall complications were defined and graded using the following: Common Terminology Criteria for Adverse Events CTCAE (v4.0) (Grade 1-5) [22]; the international Clavien-Dindo grading system [24]; the 5-grade scale described by DeOliveira et al [24].…”

Section: Primary Outcomes Overall Complicationsmentioning

confidence: 99%

“…Major complications were reported in four studies [5,15,21,22] and were defined as: 1) accordion grade ≥ 3 complications [25]; 2) complications ≥ Grade III, which were graded on severity using the Common Terminology Criteria for Adverse Events CTCAE (v4.0) (Grade 1-5) [22]; 3) Dindo-Clavien grade ≥ 3a complications [24]; 4) complications ≥ III according to the 5-grade scale described by DeOliveira et al [24]. Meta-analysis showed no significant difference between the two groups (OR = 2.22, 95% CI: 1.00-4.91; p = 0.05; Fig.…”

Section: Major Complicationsmentioning

confidence: 99%

“…Five studies reported the incidence of secondary gastric decompression in the RGD and decompression in the NGD group [15,16,[21][22][23]. Meta-analysis revealed that there was no significant difference between the postoperative reinsertion rate in the decompression group and insertion rate in the non-decompression group (OR = 1.19, 95% CI: 0.60-2.37; p = 0.61; Fig.…”

Section: Secondary Outcomes Secondary Gastric Decompressionmentioning

confidence: 99%

“…Most surgeons still routinely perform RGD after pancreatic resection in the hope that RGD would reduce postoperative complications and contribute to postoperative recovery. However, some studies have found that avoiding the use of a nasogastric tube actually speeds the return of bowel function, decreases pulmonary complications and is not associated with an increase in the anastomotic leak; thus, RGD after pancreatic resections may not be necessary for the majority of patients [15,16].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Efficacy of gastric decompression after pancreatic surgery: a systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

Background: Gastric decompression after pancreatic surgery has been a routine procedure for many years. However, this procedure has often been waived in non-pancreatic abdominal surgeries. The aim of this metaanalysis was to determine the necessity of routine gastric decompression (RGD) following pancreatic surgery. Methods: PubMed, the Cochrane Library, EMBASE, and Web of Science were systematically searched to identify relevant studies comparing outcomes of RGD and no gastric decompression (NGD) after pancreatic surgery. The overall complications, major complications, mortality, delayed gastric emptying (DGE); clinically relevant DGE (CR-DGE), postoperative pancreatic fistula (POPF), clinically relevant POPF (CR-POPF), secondary gastric decompression, and the length of hospital stay were evaluated. Results: A total of six comparative studies with a total of 940 patients were included. There were no differences between RGD and NGD groups in terms of the overall complications (OR = 1.73, 95% CI: 0.60-5.00; p = 0.31), major complications (OR = 2.22, 95% CI: 1.00-4.91; p = 0.05), incidence of secondary gastric decompression (OR = 1.19, 95% CI: 0.60-2.02; p = 0.61), incidence of overall DGE (OR = 2.74; 95% CI: 0.88-8.56; p = 0.08; I 2 = 88%), incidence of CR-POPF (OR = 1.28, 95% CI: 0.76-2.15; p = 0.36), and incidence of POPF (OR = 1.31, 95% CI: 0.81-2.14; p = 0.27). However, RGD was associated with a higher incidence of CR-DGE (OR = 5.45; 95% CI: 2.68-11.09; p < 0.001, I 2 = 35%), a higher rate of mortality (OR = 1.53; 95% CI: 1.05-2.24; p = 0.03; I 2 = 83%), and a longer length of hospital stay (WMD = 5.43, 95% CI: 0.30 to 10.56; p = 0.04; I 2 = 93%). Conclusions: Routine gastric decompression in patients after pancreatic surgery was not associated with a better recovery, and may be unnecessary after pancreatic surgery.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Primary Outcomes Overall Complicationsmentioning

confidence: 99%

Section: Major Complicationsmentioning

confidence: 99%

Section: Secondary Outcomes Secondary Gastric Decompressionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Efficacy of gastric decompression after pancreatic surgery: a systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

Nasogastric Decompression vs No Decompression After Pancreaticoduodenectomy

et al. 2020

Self Cite

View full text Add to dashboard Cite

IMPORTANCE Although standardization of pancreaticoduodenectomy (PD) has improved postoperative outcomes, morbidity remains high. Fast-track surgery programs appear to improve morbidity, and avoiding nasogastric tube decompression (NGTD), already outdated in most major abdominal surgery, is strongly suggested after PD by fast-track surgery programs but lacks high-level evidence, especially regarding safety.OBJECTIVE To assess in a randomized clinical trial whether the absence of systematic NGTD after PD reduces postoperative complications. DESIGN, SETTING, AND PARTICIPANTSThe IPOD study (Impact of the Absence of Nasogastric Decompression After Pancreaticoduodenectomy) was an open-label, prospective, single-center, randomized clinical trial conducted at a high-volume pancreatic surgery university hospital in France. In total, 155 patients who were 18 to 75 years of age and required PD for benign or malignant disease were screened for study eligibility. Key exclusion criteria were previous gastric or esophageal surgery and severe comorbidities. Patients were randomly assigned (1:1) to systematic NGTD or to no nasogastric decompression and were followed up until 90 days after surgery.INTERVENTIONS For patients without NGTD, the NGT was removed immediately after surgery, whereas for patients with NGTD, the NGT was removed 3 to 5 days after surgery. MAIN OUTCOMES AND MEASURESThe primary end point was the occurrence of postoperative complications grade II or higher using the Clavien-Dindo classification. The primary end point and safety were evaluated in the intent-to-treat population. RESULTSFrom January 2016 to August 2018, 125 screened patients were considered eligible for the study, and 111 were randomized to no NGTD (n = 52) or to NGTD (n = 59). No patient was lost to follow-up. The 2 groups had similar patient demographic and clinical characteristics at baseline. The median (interquartile range) age was 63.0 (57.0-66.5) years in the group with NGTD (38 [64.4%] were males) and 64.0 (58.0-68.0) years in the group without NGTD (31 [59.6%] were males). The postoperative complication rates grade II or higher were similar between the 2 groups (risk ratio, 0.99; 95% CI, 0.66-1.47; P > .99). Pulmonary complication rates (risk ratio, 0.59; 95% CI, 0.18-1.95; P = .44) and delayed gastric emptying rates (risk ratio, 1.07; 95% CI, 0.52-2.21; P > .99) were not significantly different between the groups. Median (interquartile) length of hospital stay for patients without NGTD was not significantly different compared with those with NGTD

show abstract

Aspiration pneumonia following oncologic digestive surgery: Proposal for a classification

Garnier

Mokart

Ewald

et al. 2021

Health Science Reports

View full text Add to dashboard Cite

Is systematic nasogastric decompression after pancreaticoduodenectomy really necessary?

Abstract: The absence of systematic nasogastric decompression after PD might reduce postoperative complications, DGE, and LOS. These encouraging results deserve to be confirmed by a prospective randomized study (NCT: 02594956).

Cited by 22 publications

References 43 publications

Efficacy of gastric decompression after pancreatic surgery: a systematic review and meta-analysis

Efficacy of gastric decompression after pancreatic surgery: a systematic review and meta-analysis

Nasogastric Decompression vs No Decompression After Pancreaticoduodenectomy

Aspiration pneumonia following oncologic digestive surgery: Proposal for a classification

Contact Info

Product

Resources

About