Signs of preoperative gastric outlet obstruction are associated with delayed
gastric emptying after pancreatoduodenectomy
Atema JJ, Eshuis WJ, Busch ORC, van Gulik TM, Gouma DJ
Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
Delayed gastric emptying (DGE) is one of the most common complications after
pancreatoduodenectomy (PD) and often requires enteral or parenteral nutritional support.
Preoperative identification of patients at risk of developing DGE could facilitate selective
placement of a feeding tube at time of operation. The aim of the present study was to
investigate whether symptoms of preoperative gastric outlet obstruction (GOO) are
associated with DGE after PD.
We investigated a series of 322 consecutive pancreatoduodenectomies from our prospective
database. The severity of DGE was determined according to the International Study Group of
Pancreatic Surgery (ISGPS) classification. The following signs of preoperative GOO were
evaluated: nausea, vomiting, loss of appetite, dysphagia, postprandial complaints, necessity
of preoperative tube feeding and weight loss.
The overall incidence of clinically relevant DGE (grade B/C) was 29%. Preoperative nausea,
vomiting and postprandial complaints were all related to a higher incidence of postoperative
DGE (43% vs 26%, P=0.013; 61% vs 26%, P<0.001; 63% vs 28%, P=0.036). Weight loss was not
associated with DGE. Patients having two or more symptoms of GOO other than weight loss,
were at a two times greater risk of developing clinically relevant DGE (55% vs 26%, P<0.001).
In multivariable logistic regression analysis including age, gender and American Society of
Anesthesiologists Classification, the presence of two or more GOO-symptoms other than
weight loss remained a significant predictor of DGE (OR 4.1, 95%CI 2.0-8.2).
Conclusions: The preoperative presence of two or more symptoms of GOO other than
weight loss, is a significant predictor of DGE after PD. By applying this novel risk factor, we
can identify patients at risk of developing DGE, in whom we can consider placement of a
feeding tube at time of operation.