Antecolic reconstruction is associated with a lower incidence of delayed gastric emptying compared to retrocolic technique after Whipple or pylorus-preserving pancreaticoduodenectomy

Qiu, Junyi; Li, Ming; Du, Changsheng

doi:10.1097/md.0000000000016663

Cited by 18 publications

(11 citation statements)

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“…Other studies have examined approaches that might influence the risk of DGE. Some meta-analyses have suggested antecolic, Billroth II to be favourable for DGE 14–16 . Of meta-analyses that specifically investigated resection of the pylorus, Klaiber and colleagues found no difference between PR and PP in a subgroup analysis of RCTs 13 , similar to the findings of this present network meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

“…The recent pylorus resection or pylorus preservation (PROPP) RCT and several meta-analyses have shown comparable DGE rates between pylorus-preserving and pylorus-resecting operations, although comparisons between the different resections are limited 3 , 12 , 13 . Previous meta-analyses have also suggested that antecolic gastrojejunostomy is the more effective route for minimizing DGE 14–16 , but again evidence is conflicting 17 . Similarly, it remains controversial whether a simple Billroth II or Roux-en-Y reconstruction makes a difference 16 , 18–21 and what value is gained from Braun enteroenterostomy, to prevent bile reflux, in terms of DGE rates 22 .…”

Section: Introductionmentioning

confidence: 99%

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Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials

et al. 2021

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Introduction Delayed gastric emptying (DGE) is frequent after pancreaticoduodenectomy (PD). Several RCTs have explored operative strategies to minimize DGE, however, the optimal combination of gastric resection approach, anastomotic route, configuration and the use of enteroenterostomy remains unclear. Methods MEDLINE, Embase and CENTRAL databases were systematically searched for RCTs comparing gastric resection (classic Whipple, pylorus-resecting, pylorus-preserving), anastomotic route (antecolic, retrocolic), configuration (loop gastroenterostomy/Billroth II, Roux-en-Y), and use of enteroenterostomy (Braun). A random-effects, Bayesian network meta-analysis with non-informative priors was conducted to determine the optimal combination of approaches to PD for minimizing DGE. Results Twenty-four RCTs, including 2526 patients and 14 approaches were included. There was some heterogeneity, although inconsistency was low. The overall incidence of DGE was 25.6 per cent (647 patients). Pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy was associated with the lowest rates of DGE and ranked the best in 35 per cent of comparisons. Classic Whipple, retrocolic, Billroth II with Braun ranked the worst for DGE in 32 per cent of comparisons. Pairwise meta-analysis of retrocolic versus antecolic route for gastrojejunostomy found increased risk of DGE with the retrocolic route (odds ratio 2.10, 95 per cent credibility interval (cr.i.) 0.92 to 4.70). Pairwise meta-analysis of enteroenterostomy found a trend towards lower DGE rates when this was used (odds ratio 1.90, 95 per cent cr.i. 0.92 to 3.90). Having a Braun enteroenterostomy ranked the best in 96 per cent of comparisons. Conclusion Based on existing RCT evidence, a pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy seems to be associated with the lowest rates of DGE. Preregistration PROSPERO submitted 23 December 2020. CRD42021227637

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials

et al. 2021

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“…Previous literature has attempted to ascertain an approach at each step of PD that is optimal for minimising DGE. A few meta-analyses have suggested antecolic, Billroth II to be favourable for DGE 16–18 . Of meta-analyses that specifically investigated the resection of the pylorus; Klaiber et al found no difference between PR and PP PD in a subgroup analysis of RCTs 12 , further confirmed by this NMA.…”

Section: Discussionmentioning

confidence: 99%

“…Pylorus resecting PD has been suggested to be favourable to pylorus preservation in reducing DGE rates as retaining the pylorus is thought to retain the propulsive activity of the stomach, but comparisons between the CW, PP and PR are limited 3,12,15 . Previous meta-analyses also suggested antecolic gastro-jejunostomy to be the most effective route for minimising DGE 16–18 , however, the evidence is conflicting 19 . Similarly, it remains controversial whether Billroth II or Roux-en-Y reconstruction is favourable 18,20–23 .…”

Section: Introductionmentioning

confidence: 99%

Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials

Varghese

Bhat

Wang

et al. 2021

Preprint

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IntroductionDelayed gastric emptying (DGE) is frequent after pancreaticoduodenectomy (PD). Several randomised controlled trials (RCTs) have explored operative strategies to minimise DGE, however, the optimal combination of gastric resection approach, anastomotic route, and configuration, role of Braun enteroenterostomy remains unclear.MethodsMEDLINE, Embase, and CENTRAL databases were systematically searched for RCTs comparing gastric resection (Classic Whipple, pylorus-resecting, and pylorus-preserving), anastomotic route (antecolic vs retrocolic) and configuration (Billroth II vs Roux-en-Y), and enteroenterostomy (Braun vs no Braun). A random-effects, Bayesian network meta-analysis with non-informative priors was conducted to determine the optimal combination of approaches to PD for minimising DGE.ResultsTwenty-four RCTs, including 2526 patients and 14 approaches were included. There was some heterogeneity, although inconsistency was low. The overall incidence of DGE was 25.6% (n = 647). Pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy was associated with the lowest rates of DGE and ranked the best in 35% of comparisons. Classic Whipple, retrocolic, Billroth II with Braun ranked the worst for DGE in 32% of comparisons. Pairwise meta-analysis of retrocolic vs antecolic route of gastro-jejunostomy found increased risk of DGE with the retrocolic route (OR 2.1, 95% CrI; 0.92 - 4.7). Pairwise meta-analysis of Braun enteroenterostomy found a trend towards lower DGE rates with Braun compared to no Braun (OR 1.9, 95% CrI; 0.92 - 3.9). Having a Braun enteroenterostomy ranked the best in 96% of comparisons.ConclusionBased on existing RCT evidence, a pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy may be associated with the lowest rates of DGE.

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“…The recent pylorus resection or pylorus preservation (PROPP) RCT and several meta-analyses have shown comparable DGE rates between pylorus-preserving and pylorus-resecting operations, although comparisons between the different resections are limited 3,12,13 . Previous meta-analyses have also suggested that antecolic gastrojejunostomy is the more effective route for minimizing DGE [14][15][16] , but again evidence is conflicting 17 . Similarly, it remains controversial whether a simple Billroth II or Roux-en-Y reconstruction makes a difference 16,[18][19][20][21] and what value is gained from Braun enteroenterostomy, to prevent bile reflux, in terms of DGE rates 22 .…”

Section: Introductionmentioning

confidence: 99%

Impact of Gastric Resection and Enteric Anastomotic Configuration on Delayed Gastric Emptying after Pancreaticoduodenectomy: A Network Meta-analysis of Randomized Trials

Varghese

Bhat

Wang

et al. 2021

HPB

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Antecolic reconstruction is associated with a lower incidence of delayed gastric emptying compared to retrocolic technique after Whipple or pylorus-preserving pancreaticoduodenectomy

Abstract: Supplemental Digital Content is available in the text

Cited by 18 publications

References 56 publications

Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials

Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials

Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials

Impact of Gastric Resection and Enteric Anastomotic Configuration on Delayed Gastric Emptying after Pancreaticoduodenectomy: A Network Meta-analysis of Randomized Trials

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