Treatment Modalities and the Role of Endoscopy for Delayed Gastric Emptying After Whipple Operation: Analysis of 53 Patients

2021 ◽  
pp. 000313482198903
Author(s):  
Yigit Mehmet Ozgun ◽  
Volkan Oter ◽  
Erol Piskin ◽  
Muhammet Kadri Colakoglu ◽  
Osman Aydin ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Interventional Procedures ◽  
Delayed Gastric Emptying ◽  
Whipple Procedure ◽  
Treatment Modalities ◽  
Abdominal Abscess ◽  
Whipple Operation ◽  
Solid Meal ◽  
Endoscopic Intervention ◽  
Secondary Causes

Background Delayed gastric emptying (DGE) is one of the most common complications after Whipple surgery. This situation delays postoperative oral food intake and prolongs hospitalization. Postoperative DGE often develops due to complications such as intra-abdominal abscess, collections, and anastomosis leaks, and these are called secondary DGE. The pathogenesis of primary DGE is still unknown, and there are insufficient data in the literature about the treatment. In this study, patients undergoing Whipple operation were examined separately as primary and secondary DGE. We discussed the causes and treatments of these patients, and also we aimed to present the therapeutic effect of endoscopy for primary DGE after the Whipple procedure. Methods From March 2014 to March 2018, data of 262 patients who underwent the Whipple procedure were collected prospectively. We observed that postoperative DGE developed in 53 (21.7%) patients. We retrospectively divided the patients by etiology into 2 groups as primary and secondary and graded DGE according to the International Study Group of Pancreatic Surgery. We defined patients who did not have secondary causes such as intra-abdominal abscess as primary DGE. Appropriate interventional procedures were performed for patients with secondary causes. We performed endoscopic intervention with therapeutic intent for patients who had primary DGE. Results The overall rate of DGE was 21.7% (n = 53) among 262 patients undergoing the Whipple procedure. It was observed that in 31 (58.5%) of these 53 patients, DGE was developed due to secondary causes. Interventional procedures were performed to these patients when necessary. A total of 22 (41.5%) patients developed primary DGE. Of these, 9 patients were grade A, 7 were grade B, and 6 were grade C. The mean duration of hospitalization for secondary DGE and primary DGE was 20.36 and 28.7 days, respectively. After endoscopic intervention with therapeutic intent to primary DGE patients, we observed that patients tolerated solid meal after 12 hours in grade B and after 26 hours in grade C patients. Conclusion Delayed gastric emptying, which is a common complication after Whipple operation and which deteriorates the quality of life and prolongs the duration of hospital stay, should be treated according to the cause. In secondary DGE, treatment modalities must be focused on intra-abdominal causes such as hematoma, collection, and abcess. We suggest that the primary DGE which is unresponsive to medical treatments could be treated endoscopically. After endoscopic intervention, patients with primary DGE can be started oral intake on the same day and discharged more quickly.

Mo1674 Treatment Modalities for Delayed Gastric Emptying Following Esophagectomy

2015 ◽  
Vol 148 (4) ◽  
pp. S-1168-S-1169
Author(s):  
Francis J. DeAsis ◽  
Matthew E. Gitelis ◽  
John G. Linn ◽  
JoAnn Carbray ◽  
Michael B. Ujiki
Keyword(s):  
Gastric Emptying ◽  
Delayed Gastric Emptying ◽  
Treatment Modalities

Delayed Gastric Emptying after Classic and Pylorus-Preserving Whipple Procedure: A Prospective Study

1997 ◽  
Vol 14 (3) ◽  
pp. 159-164 ◽  
Author(s):  
C. Sadowski ◽  
W. Uhl ◽  
H.U. Baer ◽  
P. Reber ◽  
C. Seiler ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Prospective Study ◽  
Delayed Gastric Emptying ◽  
Whipple Procedure ◽  
A Prospective Study

scholarly journals Gastroparesis in carcinoma gallbladder: a scintigraphic study

2018 ◽  
Vol 5 (6) ◽  
pp. 2086
Author(s):  
Pitchai Rajapandi ◽  
Adimoolam Eakanathan ◽  
Jeyaraj Ravishankar
Keyword(s):  
Gastric Emptying ◽  
Gastric Outlet Obstruction ◽  
Delayed Gastric Emptying ◽  
Outlet Obstruction ◽  
Solid Meal ◽  
Gastric Stasis ◽  
Carcinoma Gallbladder ◽  
Gastric Emptying Time ◽  
Scintigraphic Study ◽  
Emptying Time

Background: Gastroparesis is characterized by delayed gastric emptying in the absence of mechanical gastric outlet obstruction. There is strong association of gastroparesis with carcinoma gallbladder. The aim of the study was to find out the incidence of delayed gastric emptying in carcinoma gallbladder and its correlation with symptoms of stasis and stage of the disease.Methods: Patients diagnosed with carcinoma gallbladder and their matched controls were included in this study. Patients with mechanical gastric outlet obstruction were excluded. All patients underwent contrast enhanced computer tomography scan and radio labeled (Technitium 99) solid meal Scintigraphy study. Normal gastric emptying time was calculated from control group as Mean +2SD.Results: 30 patients were matched with 20 controls after obtaining informed consent. Upper limit of gastric emptying time is 55.09 minutes. Adenocarcinoma was the commonest histological subtype (50%), abdominal pain was the commonest symptom (86.7%) and hepatomegaly was the commonest sign (46.7%), GETt1/2 for patients was 66.72±26.52 minutes while it was 40.53±7.28 minutes in controls (p <0.05). Gastroparesis increased with advancing stage of carcinoma gallbladder (p <0.05). Symptoms of gastric stasis were seen only in 15.6% of patients.Conclusions: Patients with carcinoma gallbladder can have gastroparesis without obvious symptoms of delayed gastric emptying. This delay in gastric emptying can be documented reliably using solid meal scintigraphic study even in patients without symptoms of gastroparesis. The pathophysiology of gastroparesis needs further study. It may be prudent to remember that while performing palliative bypass surgery for gastric outflow obstruction, that in patients with carcinoma gallbladder, the gastrojejunostomy may not function as expected due to delayed gastric emptying.

W1673 Advanced Disease Not a Risk Factor for Delayed Gastric Emptying After Pancreaticoduodenectomy (Whipple Procedure)

2010 ◽  
Vol 138 (5) ◽  
pp. S-900-S-901
Author(s):  
Ronald J. Shonkwiler ◽  
Isadora C. Botwinick ◽  
John Steele ◽  
Gary Yu ◽  
John A. Chabot
Keyword(s):  
Risk Factor ◽  
Gastric Emptying ◽  
Delayed Gastric Emptying ◽  
Advanced Disease ◽  
Whipple Procedure

Acceleration of gastric emptying with electrical stimulation in a canine model of gastroparesis

1992 ◽  
Vol 262 (5) ◽  
pp. G826-G834 ◽  
Author(s):  
B. E. Bellahsene ◽  
C. D. Lind ◽  
B. D. Schirmer ◽  
O. L. Updike ◽  
R. W. McCallum
Keyword(s):  
Electrical Stimulation ◽  
Gastric Emptying ◽  
Electrical Activity ◽  
Delayed Gastric Emptying ◽  
Canine Model ◽  
Wave Activity ◽  
Intrinsic Frequency ◽  
Solid Meal ◽  
Bipolar Electrodes ◽  
Stimulation Of

We investigated the effects of electrical stimulation of the stomach on gastric emptying and the electrical activity of the stomach in 10 dogs. A model of gastroparesis was developed in five dogs using truncal vagotomy combined with injections of glucagon. Glucagon also induced electrical dysrhythmias. Bipolar electrodes were implanted in the stomach and the duodenum for electrical stimulation and for recording electrogastrograms. Gastric emptying of an isotope-labeled solid meal was assessed for 2 h. External electrical stimulation was delivered to the corpus of the stomach at its own physiological frequency to investigate whether it could restore normal gastric emptying. Such stimulation had no significant effect on gastric emptying in intact animals (45 vs. 43%: retention of isotope after 2 h) or when only vagotomy was performed (78 vs. 66%), but it significantly accelerated gastric emptying in animals with vagotomy and glucagon (from 86 to 68%). From this model of delayed gastric emptying, we suggest that electrical stimulation of the stomach at its own intrinsic frequency may recoordinate uncoupled slow wave activity induced by glucagon after vagotomy thus improving the rate of gastric emptying.

scholarly journals Acute tryptophan depletion slows gastric emptying in females

2004 ◽  
Vol 91 (3) ◽  
pp. 351-355 ◽  
Author(s):  
Michiel A. van Nieuwenhoven ◽  
Sabine D. M. Valks ◽  
Sjacko Sobczak ◽  
Willem J. Riedel ◽  
Robert-Jan M. Brummer
Keyword(s):  
Gastric Emptying ◽  
Delayed Gastric Emptying ◽  
Random Order ◽  
Amino Acid Mixture ◽  
The Body ◽  
Acute Tryptophan Depletion ◽  
Acid Mixture ◽  
Lag Phase ◽  
Tryptophan Depletion ◽  
Solid Meal

Serotonin (5-HT) is an important neurotransmitter involved in the brain–gut axis. It is possible to lower the 5-HT level in the body by means of a nutritional intervention using an amino acid mixture; the acute tryptophan depletion (ATD) method. We studied the effect of ATD on gastric emptying in healthy females, who received both ATD and placebo in a random order. Gastric emptying was measured using the [13C]octanoic acid breath test. The present data demonstrate significant differences in both gastric emptying and lag phase (Tlag) between the ATD and placebo experiment. Eight out of ten subjects showed a delayed gastric emptying in the ATD experiment. Both the gastric half-emptying time (T1/2) and the Tlag were significantly higher in the ATD experiment. T1/2 in the ATD experiment was 137·2 (range 76·2–634·8) min; T1/2 for the placebo experiment was 98·5 (range 63·7–168·8) min (P=0·028). Tlag in the ATD experiment was 83·7 (range 45·1–356·2) min; Tlag for the placebo experiment was 56·9 (range 23·2–101·2) min (P=0·007). We conclude that lowering the 5-HT level in the body using the ATD method leads to a significantly delayed gastric emptying of a solid meal. Nutritional manipulation of the serotonergic system in healthy volunteers may lead to alterations in gastrointestinal motility.

Human urocortin II, a new CRF-related peptide, displays selective CRF2-mediated action on gastric transit in rats

2002 ◽  
Vol 282 (1) ◽  
pp. G34-G40 ◽  
Author(s):  
Mulugeta Million ◽  
Céline Maillot ◽  
Paul Saunders ◽  
Jean Rivier ◽  
Wylie Vale ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Intravenous Injection ◽  
Restraint Stress ◽  
Delayed Gastric Emptying ◽  
Colonic Transit ◽  
Corticotropin Releasing Factor ◽  
Solid Meal ◽  
Mediated Action ◽  
Conscious Rats ◽  
Stimulation Of

Human urocortin (hUcn) II is a new member of the corticotropin-releasing factor (CRF) family that selectively binds to the CRF2receptor. We investigated the CRF receptors involved in mediating the effects of hUcn II and human/rat CRF (h/rCRF) on gut transit. Gastric emptying, 4 h after a solid meal, and distal colonic transit (bead expulsion time) were monitored simultaneously in conscious rats. CRF antagonists were given subcutaneously 30 min before intravenous injection of peptides or partial restraint (for 90 min). hUcn II (3 or 10 μg/kg iv) inhibited gastric emptying (by 45% and 55%, respectively) and did not influence distal colonic transit. The CRF2 peptide antagonist astressin2-B blocked hUcn II action. h/rCRF, rat Ucn, and restraint delayed gastric emptying while accelerating distal colonic transit. The gastric response to intravenous h/rCRF and restraint was blocked by the CRF2 antagonist but not by the CRF1 antagonist CP-154,526, whereas the colonic response was blocked only by CP-154,526. None of the CRF antagonists influenced postprandial gut transit. These data show that intravenous h/rCRF and restraint stress-induced delayed gastric emptying involve CRF2 whereas stimulation of distal colonic transit involves CRF1. The distinct profile of hUcn II, only on gastric transit, is linked to its CRF2 selectivity.

Restraint stress delays solid gastric emptying via a central CRF and peripheral sympathetic neuron in rats

2005 ◽  
Vol 288 (2) ◽  
pp. R427-R432 ◽  
Author(s):  
Yukiomi Nakade ◽  
Daisuke Tsuchida ◽  
Hiroyuki Fukuda ◽  
Masahiro Iwa ◽  
Theodore N. Pappas ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Restraint Stress ◽  
Delayed Gastric Emptying ◽  
Sympathetic Neuron ◽  
Inhibitory Effect ◽  
Sprague Dawley ◽  
Solid Meal ◽  
Celiac Ganglionectomy ◽  
Meal Ingestion ◽  
Sympathetic Pathway

Central corticotropin-releasing factor (CRF) delays gastric emptying through the autonomic nervous system. CRF plays an important role in mediating delayed gastric emptying induced by stress. However, it is not clear whether a sympathetic or parasympathetic pathway is involved in the mechanism of central CRF-induced inhibition of solid gastric emptying. The purpose of this study was to investigate whether 1) CRF inhibits solid gastric emptying via a peripheral sympathetic pathway and 2) stress-induced inhibition of solid gastric emptying is mediated via a central CRF and peripheral sympathetic pathways. Using male Sprague-Dawley rats, CRF was injected intracisternally with or without various adrenergic-blocking agents. To investigate whether central CRF-induced inhibition of solid gastric emptying is mediated via a peripheral sympathetic pathway, rats underwent celiac ganglionectomy 1 wk before the gastric emptying study. After solid meal ingestion (90 min), gastric emptying was calculated. To investigate the role of endogenous CRF in stress-induced delayed gastric emptying, a CRF type2receptor antagonist, astressin2-B, was intracisternally administered. Rats were subjected to a restraint stress immediately after the feeding. Intracisternal injection of CRF (0.1–1.0 μg) dose-dependently inhibited solid gastric emptying. The inhibitory effect of CRF on solid gastric emptying was significantly blocked by guanethidine, propranolol, and celiac ganglionectomy but not by phentolamine. Restraint stress significantly delayed solid gastric emptying, which was improved by astressin2-B, guanethidine, and celiac ganglionectomy. Our research suggests that restraint stress inhibits solid gastric emptying via a central CRF type2receptor and peripheral sympathetic neural pathway in rats.

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