scholarly journals P-P03 Impact of routine nasogastric decompression versus no nasogastric decompression after pancreatoduodenectomy on perioperative outcomes: A meta-analysis of available evidence

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Khaled Ammar ◽  
Chris Varghese ◽  
Thejasvin K ◽  
Viswakumar Prabakaran ◽  
Stuart Robinson ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Delayed Gastric Emptying ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Postoperative Pancreatic Fistula ◽  
Current Evidence ◽  
Perioperative Outcomes ◽  
The Impact ◽  
Nasogastric Decompression

Abstract Background This meta-analysis reviewed the current evidence on the impact of routine Nasogastric decompression (NGD) versus no NGD after pancreatoduodenectomy on perioperative outcomes.  Methods PubMed, Medline, Scopus, Embase and Cochrane databases were searched for studies reporting the role of nasogastric tube decompression after pancreatoduodenectomy on perioperative outcomes were retrieved and analysed up to January 2021.  Results Eight studies with total of 1301 patients were enrolled of which 668 patients had routine NGD. Routine NGD was associated with a higher incidence of overall delayed gastric emptying (DGE) and clinically relevant DGE (OR = 2.51, 95% CI; 1.12 - 5.63, I2= 83%, P = 0.03, and OR = 3.64, 95% CI: 1.83 – 7.25, I2 = 54%, P < 0.01, respectively). Routine NGD was also associated with a higher rate of Clavien-Dindo ≥ 2 complications (OR = 3.12, 95% CI: 1.05 – 9.28, I2 = 88%, P = 0.04), and increased length of hospital stay (MD = 2.67, 95% CI: 0.60 – 4.75, I2 = 97%, P = 0.02). There were no significant differences in overall complications (OR = 1.07, 95% CI: 0.79 – 1.46, I2 0%, P = 0.66), or postoperative pancreatic fistula (OR = 1.21, 95% CI: 0.86 – 1.72, I2 = 0%, P = 0.28) between the two groups. Conclusions Routine NGD may be associated with increased rates of DGE, major complications and longer length of stay after pancreatoduodenectomy. 

scholarly journals Total pancreatectomy and pancreatic fistula: friend or foe?

2021 ◽  
Author(s):  
Roberto Salvia ◽  
Gabriella Lionetto ◽  
Giampaolo Perri ◽  
Giuseppe Malleo ◽  
Giovanni Marchegiani
Keyword(s):  
High Risk ◽  
Pancreatic Fistula ◽  
Total Pancreatectomy ◽  
Postoperative Pancreatic Fistula ◽  
Current Evidence ◽  
Perioperative Outcomes ◽  
Surgical Morbidity ◽  
Pancreatic Anastomosis ◽  
Promising Tool

AbstractPostoperative pancreatic fistula (POPF) still represents the major driver of surgical morbidity after pancreaticoduodenectomy. The purpose of this narrative review was to critically analyze current evidence supporting the use of total pancreatectomy (TP) to prevent the development of POPF in patients with high-risk pancreas, and to explore the role of completion total pancreatectomy (CP) in the management of severe POPF. Considering the encouraging perioperative outcomes, TP may represent a promising tool to avoid the morbidity related to an extremely high-risk pancreatic anastomosis in selected patients. Surgical management of severe POPF is only required in few critical scenarios. In this context, even if anecdotal, CP might play a role as last resort in expert hands.

scholarly journals The Effect of Anakinra in Hospitalized Patients with COVID-19: An Updated Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (19) ◽  
pp. 4462
Author(s):  
Konstantinos G. Kyriakoulis ◽  
Anastasios Kollias ◽  
Garyphallia Poulakou ◽  
Ioannis G. Kyriakoulis ◽  
Ioannis P. Trontzas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Interleukin 1 ◽  
Severe Pneumonia ◽  
Hospitalized Patients ◽  
Current Evidence ◽  
Adjusted Risk ◽  
Risk Of Death ◽  
The Impact

The role of immunomodulatory agents in the treatment of hospitalized patients with COVID-19 has been of increasing interest. Anakinra, an interleukin-1 inhibitor, has been shown to offer significant clinical benefits in patients with COVID-19 and hyperinflammation. An updated systematic review and meta-analysis regarding the impact of anakinra on the outcomes of hospitalized patients with COVID-19 was conducted. Studies, randomized or non-randomized with adjustment for confounders, reporting on the adjusted risk of death in patients treated with anakinra versus those not treated with anakinra were deemed eligible. A search was performed in PubMed/EMBASE databases, as well as in relevant websites, until 1 August 2021. The meta-analysis of six studies that fulfilled the inclusion criteria (n = 1553 patients with moderate to severe pneumonia, weighted age 64 years, men 66%, treated with anakinra 50%, intubated 3%) showed a pooled hazard ratio for death in patients treated with anakinra at 0.47 (95% confidence intervals 0.34, 0.65). A meta-regression analysis did not reveal any significant associations between the mean age, percentage of males, mean baseline C-reactive protein levels, mean time of administration since symptoms onset among the included studies and the hazard ratios for death. All studies were considered as low risk of bias. The current evidence, although derived mainly from observational studies, supports a beneficial role of anakinra in the treatment of selected patients with COVID-19.

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

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.

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

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.

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

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.

scholarly journals Mechanistic role of antioxidants in rescuing delayed gastric emptying in high fat diet induced diabetic female mice

2021 ◽  
Vol 137 ◽  
pp. 111370
Author(s):  
Chethan Sampath ◽  
Derek Wilus ◽  
Mohammad Tabatabai ◽  
Michael L. Freeman ◽  
Pandu R. Gangula
Keyword(s):  
Gastric Emptying ◽  
High Fat Diet ◽  
Delayed Gastric Emptying ◽  
High Fat ◽  
Female Mice

Why Do Firms Participate in Voluntary Environmental Programs? A Meta-Analysis of the Role of Institutions, Resources, and Program Stringency

2021 ◽  
pp. 108602662199006
Author(s):  
Peter Tashman ◽  
Svetlana Flankova ◽  
Marc van Essen ◽  
Valentina Marano
Keyword(s):  
Quality Management ◽  
Prior Experience ◽  
Meta Analysis ◽  
Institutional Pressures ◽  
Environmental Programs ◽  
Voluntary Environmental Programs ◽  
Management Standards ◽  
Trade Offs ◽  
The Impact

We meta-analyze research on why firms join voluntary environmental programs (VEPs) to assess the impact of program stringency, or the extent to which they have rigorous, enforceable standards on these decisions. Stringency creates trade-offs for firms by affecting programs’ effectiveness, legitimacy, and adoption costs. Most research considers singular programs and lacks cross program variation needed to analyze program stringency’s impact. Our meta-analysis addresses this by sampling 127 studies and 23 VEPs. We begin by identifying common institutional and resource-based drivers of participation in the literature, and then analyze how program stringency moderates their impacts. Our results suggest that strictly governed VEPs encourage participation among highly visible and profitable firms, and discourage it when informal institutional pressures are higher, and firms have prior experience with other VEPs or quality management standards. We demonstrate that VEP stringency has nuanced effects on firm participation based on the institutional and resource-based factors facing them.

scholarly journals A Comprehensive Review Evaluating the Impact of Protein Source (Vegetarian vs. Meat Based) in Hepatic Encephalopathy

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 370
Author(s):  
Umair Iqbal ◽  
Ravirajsinh N. Jadeja ◽  
Harshit S. Khara ◽  
Sandeep Khurana
Keyword(s):  
Hepatic Encephalopathy ◽  
Protein Intake ◽  
Alternative Therapy ◽  
Case Series ◽  
Current Evidence ◽  
Branch Chain Amino ◽  
The Impact ◽  
Protein Diets

Hepatic encephalopathy (HE) is a common neurological consequence in patients with cirrhosis and has a healthcare burden of USD 5370 to 50,120 per patient annually. HE significantly hampers the quality of life and is a major cause of morbidity and mortality. Patients with cirrhosis are at a high risk for protein-calorie malnutrition due to altered metabolism. Current evidence has changed the old belief of protein restriction in patients with cirrhosis and now 1.2 to 1.5 g/kg/day protein intake is recommended. Case series and studies with small numbers of participants showed that a vegetarian protein diet decreases the symptoms of HE when compared to a meat-based diet, but the evidence is limited and requires further larger randomized controlled trials. However, vegetable or milk-based protein diets are good substitutes for patients averse to meat intake. Branch chain amino acids (BCAA) (leucine, isoleucine and valine) have also been shown to be effective in alleviating symptoms of HE and are recommended as an alternative therapy in patients with cirrhosis for the treatment of HE. In this review, we provide an overview of current literature evaluating the role of protein intake in the management of HE in cirrhosis.

Beaumont's Contribution to Gastric Psychophysiology: A Reappraisal

1988 ◽  
Vol 33 (7) ◽  
pp. 650-653 ◽  
Author(s):  
François M. Mai
Keyword(s):  
Gastric Emptying ◽  
Delayed Gastric Emptying ◽  
Bile Reflux ◽  
Emotional Arousal ◽  
Gastric Fistula ◽  
Physiological Changes ◽  
Digestive Process ◽  
Psychophysiological Research ◽  
Series Of Experiments

William Beaumont's monograph on the physiology of digestion which was first published in 1833, has become a classic in its field. In a series of experiments over a 10 year period on Alexis St. Martin, a 19 year old Canadian voyageur with a traumatic gastric fistula, Beaumont was the first to describe many important aspects of the digestive process. In two of the 238 experiments Beaumont noted gastric physiological changes induced by emotional arousal, these being bile reflux and delayed gastric emptying. Elsewhere in the book, but not in experimental context, Beaumont referred to non-specific changes in coloration and secretion of the mucous membrane induced by emotion. Modern gastric psychophysiological research has shown that emotional arousal increases, and withdrawal decreases, gastric acid secretion. It has also been shown conclusively that emotion can cause a reflux of bile into the stomach and it may delay gastric emptying. Although the main thrust of Beaumont's work was physiological, he must be credited with being the first investigator to draw attention to the role of emotional arousal in the digestive process.

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