Efficacy of gastric decompression after pancreatic surgery: a systematic review and meta-analysis

Abstract

Background: Gastric decompression after pancreatic surgery has been a routine procedure for many years. However, this procedure has often been waived in non-pancreatic abdominal surgeries. The aim of this metaanalysis was to determine the necessity of routine gastric decompression (RGD) following pancreatic surgery. Methods: PubMed, the Cochrane Library, EMBASE, and Web of Science were systematically searched to identify relevant studies comparing outcomes of RGD and no gastric decompression (NGD) after pancreatic surgery. The overall complications, major complications, mortality, delayed gastric emptying (DGE); clinically relevant DGE (CR-DGE), postoperative pancreatic fistula (POPF), clinically relevant POPF (CR-POPF), secondary gastric decompression, and the length of hospital stay were evaluated. Results: A total of six comparative studies with a total of 940 patients were included. There were no differences between RGD and NGD groups in terms of the overall complications (OR = 1.73, 95% CI: 0.60-5.00; p = 0.31), major complications (OR = 2.22, 95% CI: 1.00-4.91; p = 0.05), incidence of secondary gastric decompression (OR = 1.19, 95% CI: 0.60-2.02; p = 0.61), incidence of overall DGE (OR = 2.74; 95% CI: 0.88-8.56; p = 0.08; I 2 = 88%), incidence of CR-POPF (OR = 1.28, 95% CI: 0.76-2.15; p = 0.36), and incidence of POPF (OR = 1.31, 95% CI: 0.81-2.14; p = 0.27). However, RGD was associated with a higher incidence of CR-DGE (OR = 5.45; 95% CI: 2.68-11.09; p < 0.001, I 2 = 35%), a higher rate of mortality (OR = 1.53; 95% CI: 1.05-2.24; p = 0.03; I 2 = 83%), and a longer length of hospital stay (WMD = 5.43, 95% CI: 0.30 to 10.56; p = 0.04; I 2 = 93%). Conclusions: Routine gastric decompression in patients after pancreatic surgery was not associated with a better recovery, and may be unnecessary after pancreatic surgery.

Impact of routine nasogastric decompression versus no nasogastric decompression after pancreaticoduodenectomy on perioperative outcomes: meta-analysis

“…NGD is thought to decompress the stomach and reduce tension on the gastroenteric anastomosis, potentially leading to a decreased risk of anastomotic leaks and overall morbidity associated with PD. The ERAS 2019 recommendations to remove NG tubes before reversal of anaesthesia in PD have not been adopted by most surgeons, as the impact of removal of NG tubes on POPF and DGE rates was not clear 13 , 16 , 29 , 30 . Moreover, the rate of reinsertion of NG tubes was not known.…”

“…Moreover, the rate of reinsertion of NG tubes was not known. The majority of the studies on which the ERAS recommendations were based were retrospective in nature, included small sample sizes and were single-centre 13 , 16 , 29 , 30 .…”

“…A recent single-centre RCT also found that there is no significant difference in the occurrence of Clavien–Dindo grade II or higher complications, DGE or length of hospital stay following routine NGD after PD 15 . There is a lack of consensus around the necessity of routine NG tube placement after PD, with previous systematic reviews limited to only retrospective and non-randomized studies 16 .…”

Guiding post-pancreaticoduodenectomy interventions for pancreatic cancer patients utilizing decision tree models

“…To address nutritional needs and mitigate complications, clinicians frequently opt for nasogastric (NG) tube insertion alongside total parenteral nutrition (TPN) following PD. Despite the rationale behind prolonged NG tube placement post-pancreatic surgery, which aims to reduce complications such as pancreatic fistula and delayed gastric emptying, evidence from meta-analyses challenges its efficacy in reducing gastrointestinal anastomotic leakage ( 12 ). Conversely, prolonged nasogastric tube placement post-abdominal surgery is associated with a notable increase in post-pancreatic surgery pulmonary complications (PPCs) and delayed intestinal function recovery.…”