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

Abstract Background The clinical risk factors of delayed gastric emptying (DGE) in patients after pancreaticoduodenectomy (PD) remains controversial. Herein, we conducted a systematic review to quantify the associations between clinical risk factors and DGE in patients after conventional PD or pylor...

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Veröffentlicht in:European journal of surgical oncology 2013-03, Vol.39 (3), p.213-223
Hauptverfasser: Qu, H, Sun, G.R, Zhou, S.Q, He, Q.S
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container_title European journal of surgical oncology
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creator Qu, H
Sun, G.R
Zhou, S.Q
He, Q.S
description Abstract Background The clinical risk factors of delayed gastric emptying (DGE) in patients after pancreaticoduodenectomy (PD) remains controversial. Herein, we conducted a systematic review to quantify the associations between clinical risk factors and DGE in patients after conventional PD or pylorus preserving pancreaticoduodenectomy (PPPD). Methods A systematic search of electronic databases (PubMed, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1970 to 2012 was performed. Cohort, case–control studies, and randomized controlled trials that examined clinical risk factors of DGE were included. Results Eighteen studies met final inclusion criteria (total n  = 3579). From the pooled analyses, preoperative diabetes (OR 1.49, 95% CI, 1.03–2.17), pancreatic fistulas (OR 2.66, 95% CI, 1.65–4.28), and postoperative complications (OR 4.71, 95% CI, 2.61–8.50) were significantly associated with increased risk of DGE; while patients with preoperative biliary drainage (OR 0.68, 95% CI, 0.48–0.97) and antecolic reconstruction (OR 0.17, 95% CI, 0.07–0.41) had decreased risk of DGE development. Gender, malignant pathology, preoperative jaundice, intra-operative transfusion, PD vs. PPPD and early enteral feeding were not significantly associated with DGE development (all P  > 0.05). Conclusions Our findings demonstrate that preoperative diabetes, pancreatic fistulas, and postoperative complications were clinical risk factors predictive for DGE. Antecolic reconstruction and preoperative biliary drainage result in a reduction in DGE. Knowledge of these risk factors may assist in identification and appropriate referral of patients at risk of DGE.
doi_str_mv 10.1016/j.ejso.2012.12.010
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Herein, we conducted a systematic review to quantify the associations between clinical risk factors and DGE in patients after conventional PD or pylorus preserving pancreaticoduodenectomy (PPPD). Methods A systematic search of electronic databases (PubMed, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1970 to 2012 was performed. Cohort, case–control studies, and randomized controlled trials that examined clinical risk factors of DGE were included. Results Eighteen studies met final inclusion criteria (total n  = 3579). From the pooled analyses, preoperative diabetes (OR 1.49, 95% CI, 1.03–2.17), pancreatic fistulas (OR 2.66, 95% CI, 1.65–4.28), and postoperative complications (OR 4.71, 95% CI, 2.61–8.50) were significantly associated with increased risk of DGE; while patients with preoperative biliary drainage (OR 0.68, 95% CI, 0.48–0.97) and antecolic reconstruction (OR 0.17, 95% CI, 0.07–0.41) had decreased risk of DGE development. Gender, malignant pathology, preoperative jaundice, intra-operative transfusion, PD vs. PPPD and early enteral feeding were not significantly associated with DGE development (all P  &gt; 0.05). Conclusions Our findings demonstrate that preoperative diabetes, pancreatic fistulas, and postoperative complications were clinical risk factors predictive for DGE. Antecolic reconstruction and preoperative biliary drainage result in a reduction in DGE. Knowledge of these risk factors may assist in identification and appropriate referral of patients at risk of DGE.</description><identifier>ISSN: 0748-7983</identifier><identifier>EISSN: 1532-2157</identifier><identifier>DOI: 10.1016/j.ejso.2012.12.010</identifier><identifier>PMID: 23294533</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Case-Control Studies ; Cohort Studies ; Complication ; Confounding Factors (Epidemiology) ; Delayed gastric emptying ; Diabetes Complications - diagnosis ; Female ; Gastric Emptying ; Gastroparesis - etiology ; Gastroparesis - physiopathology ; Gastroparesis - prevention &amp; control ; Hematology, Oncology and Palliative Medicine ; Humans ; Male ; Odds Ratio ; Pancreatic Fistula - complications ; Pancreaticoduodenectomy ; Pancreaticoduodenectomy - adverse effects ; Pancreaticoduodenectomy - methods ; Preoperative Period ; Pylorus - physiopathology ; Randomized Controlled Trials as Topic ; Risk Factors ; Suction ; Surgery ; Treatment Outcome</subject><ispartof>European journal of surgical oncology, 2013-03, Vol.39 (3), p.213-223</ispartof><rights>Elsevier Ltd</rights><rights>2012 Elsevier Ltd</rights><rights>Copyright © 2012 Elsevier Ltd. 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Herein, we conducted a systematic review to quantify the associations between clinical risk factors and DGE in patients after conventional PD or pylorus preserving pancreaticoduodenectomy (PPPD). Methods A systematic search of electronic databases (PubMed, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1970 to 2012 was performed. Cohort, case–control studies, and randomized controlled trials that examined clinical risk factors of DGE were included. Results Eighteen studies met final inclusion criteria (total n  = 3579). From the pooled analyses, preoperative diabetes (OR 1.49, 95% CI, 1.03–2.17), pancreatic fistulas (OR 2.66, 95% CI, 1.65–4.28), and postoperative complications (OR 4.71, 95% CI, 2.61–8.50) were significantly associated with increased risk of DGE; while patients with preoperative biliary drainage (OR 0.68, 95% CI, 0.48–0.97) and antecolic reconstruction (OR 0.17, 95% CI, 0.07–0.41) had decreased risk of DGE development. Gender, malignant pathology, preoperative jaundice, intra-operative transfusion, PD vs. PPPD and early enteral feeding were not significantly associated with DGE development (all P  &gt; 0.05). Conclusions Our findings demonstrate that preoperative diabetes, pancreatic fistulas, and postoperative complications were clinical risk factors predictive for DGE. Antecolic reconstruction and preoperative biliary drainage result in a reduction in DGE. Knowledge of these risk factors may assist in identification and appropriate referral of patients at risk of DGE.</description><subject>Case-Control Studies</subject><subject>Cohort Studies</subject><subject>Complication</subject><subject>Confounding Factors (Epidemiology)</subject><subject>Delayed gastric emptying</subject><subject>Diabetes Complications - diagnosis</subject><subject>Female</subject><subject>Gastric Emptying</subject><subject>Gastroparesis - etiology</subject><subject>Gastroparesis - physiopathology</subject><subject>Gastroparesis - prevention &amp; control</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Male</subject><subject>Odds Ratio</subject><subject>Pancreatic Fistula - complications</subject><subject>Pancreaticoduodenectomy</subject><subject>Pancreaticoduodenectomy - adverse effects</subject><subject>Pancreaticoduodenectomy - methods</subject><subject>Preoperative Period</subject><subject>Pylorus - physiopathology</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Risk Factors</subject><subject>Suction</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0748-7983</issn><issn>1532-2157</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc2r1DAUxYMovvHpP-BCsnTTMR_tNBURHoNf8MCFug5pcvNIX9uMuanSrX-5KTO6cCEEwk3OOXB_h5DnnO0544dXwx4GjHvBuNiXwzh7QHa8kaISvGkfkh1ra1W1nZJX5AniwBjrZNs9JldCiq5upNyRX8cxzMGakaaA99Qbm2NCGj11MJoVHL0zmFOwFKZTXsN8R8NMTyYHmDNS4zOkMs42QXmz0S3RwQwlZVpf0xuKK2aYti-a4EeAn9TMjk6QTWVmM64Y8Cl55M2I8OxyX5Nv7999PX6sbj9_-HS8ua1s3ba54pL5zjWKucYzyQ7AywAHKWzvoFW-5Yr1jZMMTM36vpHGcyMOrvcClAMjr8nLc-4pxe8LYNZTQAvjaGaIC2oulOq6RnBVpOIstSkiJvD6lMJk0qo50xt7PeiNvd7YF6Mu7IvpxSV_6Sdwfy1_YBfBm7MAypaFRdJoC0YLLqRCTLsY_p__9h-7vXR3DyvgEJdUiJY9NBaD_rK1v5XPS4isOyF_AzzNrbQ</recordid><startdate>20130301</startdate><enddate>20130301</enddate><creator>Qu, H</creator><creator>Sun, G.R</creator><creator>Zhou, S.Q</creator><creator>He, Q.S</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130301</creationdate><title>Clinical risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: A systematic review and meta-analysis</title><author>Qu, H ; Sun, G.R ; Zhou, S.Q ; He, Q.S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c477t-130f9d580d5f0306e1d58e632cbde78f7180b5d30ea40bb53af1a26dbf2e8dea3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Case-Control Studies</topic><topic>Cohort Studies</topic><topic>Complication</topic><topic>Confounding Factors (Epidemiology)</topic><topic>Delayed gastric emptying</topic><topic>Diabetes Complications - diagnosis</topic><topic>Female</topic><topic>Gastric Emptying</topic><topic>Gastroparesis - etiology</topic><topic>Gastroparesis - physiopathology</topic><topic>Gastroparesis - prevention &amp; control</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Male</topic><topic>Odds Ratio</topic><topic>Pancreatic Fistula - complications</topic><topic>Pancreaticoduodenectomy</topic><topic>Pancreaticoduodenectomy - adverse effects</topic><topic>Pancreaticoduodenectomy - methods</topic><topic>Preoperative Period</topic><topic>Pylorus - physiopathology</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Risk Factors</topic><topic>Suction</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Qu, H</creatorcontrib><creatorcontrib>Sun, G.R</creatorcontrib><creatorcontrib>Zhou, S.Q</creatorcontrib><creatorcontrib>He, Q.S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Qu, H</au><au>Sun, G.R</au><au>Zhou, S.Q</au><au>He, Q.S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: A systematic review and meta-analysis</atitle><jtitle>European journal of surgical oncology</jtitle><addtitle>Eur J Surg Oncol</addtitle><date>2013-03-01</date><risdate>2013</risdate><volume>39</volume><issue>3</issue><spage>213</spage><epage>223</epage><pages>213-223</pages><issn>0748-7983</issn><eissn>1532-2157</eissn><abstract>Abstract Background The clinical risk factors of delayed gastric emptying (DGE) in patients after pancreaticoduodenectomy (PD) remains controversial. Herein, we conducted a systematic review to quantify the associations between clinical risk factors and DGE in patients after conventional PD or pylorus preserving pancreaticoduodenectomy (PPPD). Methods A systematic search of electronic databases (PubMed, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1970 to 2012 was performed. Cohort, case–control studies, and randomized controlled trials that examined clinical risk factors of DGE were included. Results Eighteen studies met final inclusion criteria (total n  = 3579). From the pooled analyses, preoperative diabetes (OR 1.49, 95% CI, 1.03–2.17), pancreatic fistulas (OR 2.66, 95% CI, 1.65–4.28), and postoperative complications (OR 4.71, 95% CI, 2.61–8.50) were significantly associated with increased risk of DGE; while patients with preoperative biliary drainage (OR 0.68, 95% CI, 0.48–0.97) and antecolic reconstruction (OR 0.17, 95% CI, 0.07–0.41) had decreased risk of DGE development. Gender, malignant pathology, preoperative jaundice, intra-operative transfusion, PD vs. PPPD and early enteral feeding were not significantly associated with DGE development (all P  &gt; 0.05). Conclusions Our findings demonstrate that preoperative diabetes, pancreatic fistulas, and postoperative complications were clinical risk factors predictive for DGE. Antecolic reconstruction and preoperative biliary drainage result in a reduction in DGE. Knowledge of these risk factors may assist in identification and appropriate referral of patients at risk of DGE.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>23294533</pmid><doi>10.1016/j.ejso.2012.12.010</doi><tpages>11</tpages></addata></record>
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subjects Case-Control Studies
Cohort Studies
Complication
Confounding Factors (Epidemiology)
Delayed gastric emptying
Diabetes Complications - diagnosis
Female
Gastric Emptying
Gastroparesis - etiology
Gastroparesis - physiopathology
Gastroparesis - prevention & control
Hematology, Oncology and Palliative Medicine
Humans
Male
Odds Ratio
Pancreatic Fistula - complications
Pancreaticoduodenectomy
Pancreaticoduodenectomy - adverse effects
Pancreaticoduodenectomy - methods
Preoperative Period
Pylorus - physiopathology
Randomized Controlled Trials as Topic
Risk Factors
Suction
Surgery
Treatment Outcome
title Clinical risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: A systematic review and meta-analysis
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