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Delayed Gastric Emptying (DGE) Following Total Pancreatectomy with Islet Auto Transplantation in Patients with Chronic Pancreatitis

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The prevalence and factors associated with delayed gastric emptying (DGE) in patients undergoing total pancreatectomy with islet auto transplantation (TP-IAT) for chronic pancreatitis are unknown.

Methods

A retrospective study of all patients who underwent TP-IAT at Johns Hopkins Hospital (JHH) from August 2011 to November 2014 was performed. The International Study Group of Pancreatic Surgery (ISGPS) clinical grading of DGE was used in this study.

Key Results

A total of 39 patients with chronic pancreatitis underwent TP-IAT during the study period. The prevalence of DGE following TP-IAT was 35.9 %. Twenty-five patients (64.1 %) had no DGE, 10 (25.6 %) had grade A, 2 (5.1 %) had grade B, and 2 patients (5.1 %) had grade C DGE. Patients with DGE had 5.7-fold higher odds of having a hospital length of stay (LOS) greater than 14 days (OR 5.70, 95 % CI 1.37–23.76, p = 0.02). Patients undergoing laparoscopic TP-IAT had significantly shorter LOS (10.5 vs. 14 days, p = 0.02) and lower need for prokinetics (0.01) during the postoperative course.

Conclusions and Inferences

DGE is common after TP-IAT and can prolong LOS. Laparoscopic TP-IAT lowers LOS and need for prokinetics postoperatively. Further studies are needed to determine if laparoscopic approaches will improve long-term dysmotility.

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Abbreviations

TP-IAT:

Total pancreatectomy with islet auto transplantation

ISGPS:

International study group of pancreatic surgery

DGE:

Delayed gastric emptying

LOS:

Length of stay

References

  1. Beilman G. Pancreatitis: Is TPIAT the answer for treatment of chronic pancreatitis? Nature Reviews Gastroenterology & Hepatology 2014.

  2. Morgan K, Owczarski S, Borckardt J, Madan A, Nishimura M, Adams D. Pain control and quality of life after pancreatectomy with islet autotransplantation for chronic pancreatitis. J Gastrointest Surg 2012;16:129-33; discussion 33–4. doi 10.1007/s11605-011-1744-y.

    Article  PubMed  Google Scholar 

  3. Wilson GC, Ahmad SA, Schauer DP, Eckman MH, Abbott DE. Cost-Effectiveness of Total Pancreatectomy and Islet Cell Autotransplantation for the Treatment of Minimal Change Chronic Pancreatitis. J Gastrointest Surg 2014;6:6.

    Google Scholar 

  4. Emick DM, Riall TS, Cameron JL, et al. Hospital readmission after pancreaticoduodenectomy. J Gastrointest Surg 2006;10:1243-52.

    Article  PubMed  Google Scholar 

  5. Fisher AV, Sutton JM, Wilson GC, et al. High readmission rates after surgery for chronic pancreatitis. Surgery;156:787-96.

  6. Liu QY, Li L, Xia HT, Zhang WZ, Cai SW, Lu SC. Risk factors of delayed gastric emptying following pancreaticoduodenectomy. ANZ J Surg 2014;13:12850.

    Google Scholar 

  7. Paraskevas K, Avgerinos C, Manes C, Lytras D, Dervenis C. Delayed gastric emptying is associated with pylorus-preserving but not classical Whipple pancreaticoduodenectomy: a review of the literature and critical reappraisal of the implicated pathomechanism. World J Gastroenterol 2006;12:5951-8.

    PubMed Central  PubMed  Google Scholar 

  8. Holzer HH, Turkelson CM, Solomon TE, Raybould HE. Intestinal lipid inhibits gastric emptying via CCK and a vagal capsaicin-sensitive afferent pathway in rats. Am J Physiol 1994;267:G625-9.

    CAS  PubMed  Google Scholar 

  9. Suzuki H, Mochiki E, Haga N, Shimura T, Itoh Z, Kuwano H. Effect of duodenectomy on gastric motility and gastric hormones in dogs. Ann Surg 2001;233:353-9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Yeo C, Barry M, Sauter P, et al. Erythromycin accelerates gastric emptying after pancreaticoduodenectomy. A prospective, randomized, placebo-controlled trial. Ann Surg 1993;218:229-37; discussion 37-8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Kim D, Hindenburg A, Sharma S, et al. Is Pylorospasm a Cause of Delayed Gastric Emptying After Pylorus-Preserving Pancreaticoduodenectomy? Ann Surg Oncol 2005;12:222-7.

    Article  PubMed  Google Scholar 

  12. Ueno TTA, Hamanaka Y, Tsurumi M, Suzuki T. . A proposal mechanism of early delayed gastric emptying after pylorus preserving pancreatoduodenectomy. Hepato-gastroenterology 1995;42:269-74.

    CAS  PubMed  Google Scholar 

  13. Walsh TN, Rode J, Theis BA, Russell RC. Minimal change chronic pancreatitis. Gut 1992;33:1566-71.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Wallace MB, Hawes RH, Durkalski V, et al. The reliability of EUS for the diagnosis of chronic pancreatitis: interobserver agreement among experienced endosonographers. Gastrointest Endosc 2001;53:294-9.

    Article  CAS  PubMed  Google Scholar 

  15. Kloppel G, Maillet B. Pseudocysts in chronic pancreatitis: a morphological analysis of 57 resection specimens and 9 autopsy pancreata. Pancreas 1991;6:266-74.

    Article  CAS  PubMed  Google Scholar 

  16. Wente M, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007;142:761-8.

    Article  PubMed  Google Scholar 

  17. Traverso LW, Hashimoto Y. Delayed gastric emptying: the state of the highest level of evidence. J Hepatobiliary Pancreat Surg 2008;15:262-9.

    Article  PubMed  Google Scholar 

  18. Hashimoto Y, Traverso LW. Incidence of pancreatic anastomotic failure and delayed gastric emptying after pancreatoduodenectomy in 507 consecutive patients: use of a web-based calculator to improve homogeneity of definition. Surgery 2010;147:503-15.

    Article  PubMed  Google Scholar 

  19. Malleo G, Crippa S, Butturini G, et al. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors. HPB 2010;12:610-8.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Akizuki E, Kimura Y, Nobuoka T, et al. Reconsideration of postoperative oral intake tolerance after pancreaticoduodenectomy: prospective consecutive analysis of delayed gastric emptying according to the ISGPS definition and the amount of dietary intake. Ann Surg 2009;249:986-94.

    Article  PubMed  Google Scholar 

  21. Welsch T, Borm M, Degrate L, Hinz U, Buchler MW, Wente MN. Evaluation of the International Study Group of Pancreatic Surgery definition of delayed gastric emptying after pancreatoduodenectomy in a high-volume centre. Br J Surg 2010;97:1043-50.

    Article  CAS  PubMed  Google Scholar 

  22. Park JS, Hwang HK, Kim JK, et al. Clinical validation and risk factors for delayed gastric emptying based on the International Study Group of Pancreatic Surgery (ISGPS) Classification. Surgery 2009;146:882-7.

    Article  PubMed  Google Scholar 

  23. Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg 2010;145:19-23.

    Article  PubMed  Google Scholar 

  24. Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg 2012;215:810-9.

    Article  PubMed  Google Scholar 

  25. Croome KP, Farnell MB, Que FG, et al. Pancreaticoduodenectomy with Major Vascular Resection: a Comparison of Laparoscopic Versus Open Approaches. J Gastrointest Surg 2014;2:2.

    Google Scholar 

  26. Li YB, Wang X, Wang MJ, Yang ZG, Peng B. [Delayed gastric emptying after laparoscopic versus open pancreaticoduodenectomy: a comparative study]. Zhonghua Wai Ke Za Zhi 2013;51:304-7.

    PubMed  Google Scholar 

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Acknowledgments

GKJ, EMS, VKS, and PJP were involved in the concept and design of this study. GKJ reviewed patient records, extracted data, performed statistical analysis, and wrote the first draft of the manuscript. All authors critically appraised and revised the manuscript. All authors gave final approval for submission of the manuscript.

Funding

No funding declared.

Conflict of Interest

No competing interests declared.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA

    George K. John, Vikesh K. Singh, Pankaj J. Pasricha, Amitasha Sinha, Elham Afghani & Ellen M. Stein

  2. Division of Surgical Oncology, Johns Hopkins Hospital, Baltimore, MD, USA

    Christi Walsh, Kenzo Hirose & Martin A. Makary

  3. Division of Transplant Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Daniel Warren, Zhaoli Sun, Niraj Desai, Kenzo Hirose & Martin A. Makary

  4. Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins Hospital, Baltimore, MD, USA

    Rita R. Kalyani & Erica Hall

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  1. George K. John
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  14. Ellen M. Stein
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Corresponding author

Correspondence to Ellen M. Stein.

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John, G.K., Singh, V.K., Pasricha, P.J. et al. Delayed Gastric Emptying (DGE) Following Total Pancreatectomy with Islet Auto Transplantation in Patients with Chronic Pancreatitis. J Gastrointest Surg 19, 1256–1261 (2015). https://doi.org/10.1007/s11605-015-2848-6

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  • DOI: https://doi.org/10.1007/s11605-015-2848-6

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