712 Gastric Emptying Procedure in Oesophagectomy: Meta-Analysis of Surgical Pyloroplasty vs Nil Intervention

Abstract Introduction Surgical pyloroplasty is often performed to reduce the rate of delayed gastric emptying. However, the clinical significance of this is not clear. The aim of this meta-analysis is to compare the rates of delayed gastric emptying, anastomotic leak, pulmonary complications, need for further pyloric intervention, and mortality in those patients undergoing pyloroplasty following oesophagectomy and those who do not. Method Relevant Randomised Control Trials and Cohort Studies were identified. The first group had no drainage procedure following oesophagectomy, whereas the second group underwent a drainage procedure (pyloroplasty). A random effects meta-analysis model was used to compare the outcomes. Results 12 papers were utilised in the analysis, comprising a total 2567 patients. No significant differences were found between the two groups with regards to delayed gastric emptying (RR 0.87 [95% CI: 0.47 – 1.62], p = 0.66), anastomotic leak (RR 1.20 [95% CI: 0.82 – 1.74], p = 0.34), pulmonary complications (RR 1.04 [95% CI: 0.79 – 1.37], p = 0.79), need for further pyloric intervention (RR 1.44 [95% CI: 0.87 – 2.37], p = 0.16), and mortality (RR 1.18 [95% CI: 0.43 – 3.23], p = 0.75). Conclusions Surgical pyloric drainage procedures do not improve outcomes for patients undergoing oesophagectomy, nor does omitting the procedure worsens the outcomes.

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Systematic review and meta-analysis of the influence of prophylactic pyloric balloon dilatation in the prevention of early delayed gastric emptying after oesophagectomy

Diseases of the Esophagus ◽

10.1093/dote/doab062 ◽

2021 ◽

Author(s):

Mohamed Abdelrahman ◽

Arun Ariyarathenam ◽

Richard Berrisford ◽

Lee Humphreys ◽

Grant Sanders ◽

...

Keyword(s):

Gastric Emptying ◽

Anastomotic Leak ◽

Balloon Dilatation ◽

Delayed Gastric Emptying ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Primary Outcome Measure ◽

Cochrane Library ◽

Secondary Outcome ◽

Optimal Approach

SUMMARY Background: Early delayed gastric emptying (DGE) occurs in up to 50% of patients following oesophagectomy, which can contribute to increased anastomotic leak and respiratory infection rates. Although the treatment of DGE in the form of pyloric balloon dilatation (PBD) post-operatively is well established, there is no consensus on the optimal approach in the prevention of DGE. The aim of this review was to determine the efficacy of prophylactic PBD in the prevention of DGE following oesophagectomy. Method: PubMed, MEDLINE and the Cochrane Library (January 1990 to April 2021) were searched for studies reporting the outcomes of prophylactic PBD in patients who underwent oesophagectomy. The primary outcome measure was the rate of DGE. Secondary outcome measures include anastomotic leak rate and length of hospital stay. Results: Three studies with a total of 203 patients [mean age 63 (26–82) years, 162 males (79.8%)] were analyzed. PBD with a 20-mm balloon was performed in 165 patients (46 patients had PBD and botox therapy) compared with 38 patients who had either no intervention or botox alone (14 patients). The pooled rates of early DGE [16.27%, 95% CI (12.29–20.24) vs. 39.02% (38.87–39.17) (P < 0.001)] and anastomotic leak [8.55%, 95% CI (8.51–8.59) vs. 12.23% (12.16–12.31), P < 0.001] were significantly lower in the PBD group. Conclusion: Prophylactic PBD with a 20-mm balloon significantly reduced the rates of early delayed gastric emptying and anastomotic leak following oesophagectomy.

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Meta-analysis of delayed gastric emptying after pylorus-preserving versus pylorus-resecting pancreatoduodenectomy

British Journal of Surgery ◽

10.1002/bjs.10771 ◽

2018 ◽

Vol 105 (4) ◽

pp. 339-349 ◽

Cited By ~ 13

Author(s):

U. Klaiber ◽

P. Probst ◽

O. Strobel ◽

C. W. Michalski ◽

C. Dörr-Harim ◽

...

Keyword(s):

Gastric Emptying ◽

Delayed Gastric Emptying ◽

Meta Analysis

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Effect of antecolic or retrocolic route of gastroenteric anastomosis on delayed gastric emptying after pancreaticoduodenectomy: A meta-analysis of randomized controlled trials

Pancreatology ◽

10.1016/j.pan.2015.11.003 ◽

2016 ◽

Vol 16 (1) ◽

pp. 142-150 ◽

Cited By ~ 6

Author(s):

Dong Qian ◽

Zipeng Lu ◽

Richard Jackson ◽

Junli Wu ◽

Xinchun Liu ◽

...

Keyword(s):

Gastric Emptying ◽

Randomized Controlled Trials ◽

Delayed Gastric Emptying ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled

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Braun enteroenterostomy reduces delayed gastric emptying: A systematic review and meta-analysis

International Journal of Surgery ◽

10.1016/j.ijsu.2015.09.038 ◽

2015 ◽

Vol 23 ◽

pp. 75-81 ◽

Cited By ~ 4

Author(s):

Ming-quan Huang ◽

Mou Li ◽

Jing-yu Mao ◽

Bo-le Tian

Keyword(s):

Systematic Review ◽

Gastric Emptying ◽

Delayed Gastric Emptying ◽

Meta Analysis ◽

Braun Enteroenterostomy

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Clinical risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: A systematic review and meta-analysis

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2012.12.010 ◽

2013 ◽

Vol 39 (3) ◽

pp. 213-223 ◽

Cited By ~ 56

Author(s):

H. Qu ◽

G.R. Sun ◽

S.Q. Zhou ◽

Q.S. He

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Gastric Emptying ◽

Delayed Gastric Emptying ◽

Meta Analysis ◽

Clinical Risk Factors ◽

Clinical Risk

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Individual patient data meta-analysis of delayed gastric emptying after pylorus-preserving versus pylorus-resecting pancreatoduodenectomy

British Journal of Surgery ◽

10.1093/bjs/znab202.030 ◽

2021 ◽

Vol 108 (Supplement_4) ◽

Author(s):

P Probst ◽

U Klaiber ◽

S Seide ◽

M Kawai ◽

I Matsumoto ◽

...

Keyword(s):

Gastric Emptying ◽

Delayed Gastric Emptying ◽

Individual Patient Data ◽

Meta Analysis ◽

International Study ◽

Postoperative Outcome ◽

Patient Data ◽

Individual Patient Level ◽

Quantitative Synthesis ◽

Meta Analyses

Abstract Objective Some studies have indicated that resecting the pylorus during partial pancreatoduodenectomy (PD) may lead to reduced delayed gastric emptying (DGE). Randomized controlled trials (RCTs) showed conflicting results regarding superiority of pylorus-resecting PD (prPD) compared to the pylorus-preserving procedure (ppPD). The aim of this individual patient data meta-analysis was to investigate risk factors on an individual patient level which may explain the observed differences between the existing RCTs. Methods RCTs comparing ppPD and prPD were searched systematically in MEDLINE, Web of Science and CENTRAL. Individual patient data (IPD) from existing RCTs were included. The primary endpoint was DGE according to the International Study Group of Pancreatic Surgery (ISGPS) adjusted for age, sex and body-mass-index (BMI). The meta-regression model was applied to the IPD of the RCTs. Mixed effects models were applied to perform meta-analyses. Results IPD from 418 patients (three RCTs) were used for quantitative synthesis. There was no significant statistical difference between ppPD and prPD regarding DGE adjusted for age, sex and BMI (OR 0.72; 95%-CI: 0.41 to 1.22) and DGE grade (RR 1.01; 95%-CI: 0.64 to 1.57). Regarding other relevant perioperative and postoperative outcome parameters, there were also no significant differences among the two techniques. Conclusion This IPD meta-analysis comparing preservation and resection of the pylorus during PD confirmed that the resection of the pylorus is not superior to the pylorus-preserving procedure regarding DGE. The pylorus should therefore be preserved whenever possible. Further RCT are futile, because their results are unlikely to change the pooled estimate for DGE.

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Comparison of surgical outcomes between isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy after pancreaticoduodenectomy: A systematic review and meta-analysis

10.21203/rs.3.rs-17682/v2 ◽

2020 ◽

Author(s):

lyu yunxiao ◽

Bin Wang ◽

Yunxiao Cheng ◽

Yueming Xu ◽

WeiBing Du

Keyword(s):

Gastric Emptying ◽

Pancreatic Fistula ◽

Delayed Gastric Emptying ◽

Meta Analysis ◽

Operation Time ◽

Bile Leakage ◽

Reoperation Rate ◽

Postoperative Pancreatic Fistula ◽

Controlled Trials ◽

Cochrane Central Register

Abstract Background We aimed to compare the safety and effectiveness of the following procedures after pancreaticoduodenectomy: isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy.Methods We performed a systematic search of the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 January 2020. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using STATA 12.0 statistical software.Results Thirteen studies involving 1942 patients were included in this study. Pooled analysis showed that reoperation rates following isolated pancreaticojejunostomy were lower reoperation than with conventional pancreaticojejunostomy (OR=0.36, 95% CI: 0.15–0.86, p=0.02, respectively), and that isolated pancreaticojejunostomy required longer operation time vs conventional pancreaticojejunostomy (WMD=43.61, 95% CI: 21.64–65.58, P=0.00). Regarding postoperative pancreatic fistula, clinically-relevant postoperative pancreatic fistula, delayed gastric emptying, clinically-relevant delayed gastric emptying, bile leakage, hemorrhage, reoperation, length of postoperative hospital stay, major complications, overall complications, and mortality, we found no significant differences for either isolated pancreaticojejunostomy versus conventional pancreaticojejunostomy or isolated gastrojejunostomy versus conventional pancreaticojejunostomy.Conclusions This study showed that isolated pancreaticojejunostomy was associated with a lower reoperation rate, but required longer operation time vs conventional pancreaticojejunostomy. Considering the limitations, high-quality randomized controlled trials are required.

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