Enteral Nutrition and Biliopancreatic Diversion Effectively Minimize Impacts of Gastroparesis After Pancreaticoduodenectomy

Since gastroparesis is unavoidable in a certain proportion of patients after pancreaticoduodenectomy, measures to avoid its occurrence or at least minimize its impact are needed. A prospective randomized trial was performed to test the effectiveness of biliopancreatic diversion with modified Roux-en-Y gastrojejunostomy reconstruction and of enteral feeding to minimize impacts of gastroparesis after pancreaticoduodenectomy. In total, 247 patients with periampullary tumors were randomized at the time of pancreaticoduodenectomy to have either (1) modified Roux-en-Y gastrojejunostomy reconstruction (by creating a side-to-side jejunojejunostomy between afferent and efferent loop and closing the afferent loop with a TA-30-3.5 stapler) and insertion of a jejunostomy feeding tube (modified group) or (2) conventional gastric bypass (control group). Outcomes including complications, duration of nasogastric tube placement, and length of hospital stay were followed prospectively. Gastroparesis occurred in 20 patients (16.3%) in the modified group and 27 patients in the control group (21.7%, P = 0.27). However, the International Study Group of Pancreatic Surgery grades of gastroparesis were significantly lower in the modified group (10A, 5B, 5C) than in the control group (4A, 5B, 18C, P = 0.01). Modified procedure does not reduce the risk of gastroparesis but appears to reduce the severity when it occurs.