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Does the Ileal Brake Contribute to Delayed Gastric Emptying After Pancreatoduodenectomy

Published on Feb 1, 2017in Digestive Diseases and Sciences2.94
· DOI :10.1007/s10620-016-4402-0
Savio George Barreto15
Estimated H-index: 15
(Flinders Medical Centre),
John A. Windsor50
Estimated H-index: 50
(University of Auckland)
Cite
Abstract
Delayed gastric emptying (DGE) represents a significant cause for morbidity following pancreatoduodenectomy (PD). At a time when no specific and universally effective therapy exists to treat these patients, elucidating other potential (preventable or treatable) mechanisms for DGE is important. The aim of the manuscript was to test the hypothesis that ileal brake contributes to DGE in PD patients receiving jejunal tube feeding by systematically reviewing experimental and clinical literature. A series of clinically relevant questions were framed related to the potential role of the ileal brake in development of DGE post-PD and formed the basis of targeted literature searches. A comprehensive search of major reference databases from January 1980 to June 2015 was carried out which included human and animal studies. The ileal brake is a feedback loop neurally mediated by the vagus and sympatho-adrenergic pathways and hormonally by gut peptides including glucagon-like peptide-1, peptide YY (PYY), and neurotensin. The most potent stimulus for this inhibitory reflex is intra-ileal fat. There is evidence to indicate the role of an inhibitory reflex (on gastric emptying) mediated by PYY and CCK which, in turn, are stimulated by nutrient delivery into the distal small intestine providing indirect support to the role of ileal brake in post-PD DGE. The ileal brake is a likely factor contributing to DGE post-PD. While there has been no study to directly test this hypothesis, there is compelling indirect evidence to support it. Designing a trial that would answer such a question appears to be the most appropriate way forward.
  • References (158)
  • Citations (4)
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References158
Newest
Published on Jan 1, 2016in Anz Journal of Surgery1.60
Qi-Yu Liu2
Estimated H-index: 2
,
Li Li1
Estimated H-index: 1
+ 3 AuthorsShi-Chun Lu1
Estimated H-index: 1
(Chinese PLA General Hospital)
Background This study aims to explore the morbidity and risk factors of delayed gastric emptying (DGE) following pancreaticoduodenectomy. Methods Between 1 January 2013 and 31 December 2013, data from 196 consecutive patients who underwent pancreaticoduodenectomy in the Chinese PLA General Hospital were recorded retrospectively. A total of 17 factors were examined with univariate analysis, and multivariate logistic regression analysis was used to estimate relative risks. Results DGE occurred in ...
Published on Sep 1, 2015in Updates in Surgery
T. Courvoisier2
Estimated H-index: 2
,
Gianluca Donatini2
Estimated H-index: 2
+ 3 AuthorsJ.-P. Richer12
Estimated H-index: 12
Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PDD) significantly contributing to post-operative morbidity. Clinical risk factors for DGE occurrence after PDD remain controversial. From January 2004 to December 2011, a total of 132 patients underwent PDD for either malignancies (73.5 %) or benign diseases (26.5 %) in one single universitary center. Post-operative mortality and morbidity were, respectively, 3 and 44.7 %. DGE has been defined in accordance w...
Published on Aug 1, 2015in Journal of Gastrointestinal Surgery2.69
Mena M. Hanna7
Estimated H-index: 7
(UM: University of Miami),
Rahul Gadde7
Estimated H-index: 7
(UM: University of Miami)
+ 5 AuthorsDanny Yakoub7
Estimated H-index: 7
(UM: University of Miami)
Background Delayed gastric emptying (DGE) is one of the main complications after pancreaticoduodenectomy (PD). Literature review and meta-analysis were used to evaluate whether subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) may have less incidence than pylorus-preserving pancreaticoduodenectomy (PPPD).
Published on Jun 1, 2015in American Journal of Surgery2.20
Bin Xu6
Estimated H-index: 6
(Tongji University),
Hongbo Meng9
Estimated H-index: 9
(Tongji University)
+ 3 AuthorsZhenshun Song13
Estimated H-index: 13
(Tongji University)
Abstract Background Modified digestive reconstruction during pancreaticoduodenectomy (PD) may affect the postoperative incidence of delayed gastric emptying (DGE). The purpose of this study is to investigate whether Braun enteroenterostomy following PD can reduce the incidence of DGE. Methods Four hundred seven patients who received PD with child reconstruction from June 2000 to March 2013 were divided into 2 groups: 206 patients with Braun enteroenterostomy (Child-Braun group) and 201 patients ...
Published on Jun 1, 2015in Hpb3.05
Jamie R. Robinson7
Estimated H-index: 7
(Vandy: Vanderbilt University),
Paula Marincola2
Estimated H-index: 2
(Vandy: Vanderbilt University)
+ 3 AuthorsAj Parikh36
Estimated H-index: 36
(Vandy: Vanderbilt University)
Abstract Background Delayed gastric emptying (DGE) is a frequent cause of morbidity, prolonged hospital stay and readmission after a pancreaticoduodenectomy (PD). We sought to evaluate predictive peri-operative factors for DGE after a PD. Methods Four hundred and sixteen consecutive patients who underwent a PD at our tertiary referral centre were identified. Univariate and multivariate (MV) logistic regression models were used to assess peri-operative factors associated with the development of c...
Published on Jun 1, 2015in Journal of Gastrointestinal Surgery2.69
Ayman El Nakeeb17
Estimated H-index: 17
(Mansoura University),
Waleed Askr5
Estimated H-index: 5
(Mansoura University)
+ 5 AuthorsMohamed Abd ElWahab5
Estimated H-index: 5
(Mansoura University)
Background Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PD). This study was designed to evaluate perioperative risk variables for DGE after PD and analyze the factors that predict its severity.
Published on Apr 1, 2015in Journal of The American College of Surgeons4.45
John L. Cameron119
Estimated H-index: 119
(Johns Hopkins University),
Jin He22
Estimated H-index: 22
(Johns Hopkins University)
Background The first successful local resection of a periampullary tumor was performed by Halsted in 1898. Kausch performed the first regional resection in 1909, and the operation was popularized by Whipple in 1935. The operation was infrequently performed until the 1980s and 1990s. Study Design Two thousand consecutive pancreaticoduodenectomies performed by 1 surgeon (JLC) from the 1960s to the 2000s were retrospectively reviewed from a prospectively maintained database. The first 1,000 were pe...
Published on Mar 1, 2015in Pancreas2.67
Adarsh Chaudhary17
Estimated H-index: 17
,
Savio George Barreto15
Estimated H-index: 15
+ 3 AuthorsTanveer Singh3
Estimated H-index: 3
ObjectivesShorter hospital stay after pancreatoduodenectomy (PD) is a desired goal. Implementation of enhanced recovery after surgery (ERAS) protocols can possibly help in achieving this target. We aimed to determine the factors influencing the successful implementation of ERAS protocols by analyzin
Published on Mar 1, 2015in Hpb3.05
Richard Bell5
Estimated H-index: 5
,
Sanjay Pandanaboyana9
Estimated H-index: 9
+ 3 AuthorsAndrew M. Smith1
Estimated H-index: 1
(Auckland City Hospital)
Abstract Introduction Delayed gastric emptying (DGE) is a common complication after a pylorus‐preserving pancreatoduodenectomy (PPPD) and is associated with significant morbidity. This study determines whether DGE is affected by antecolic (AC) or retrocolic (RC) reconstruction after a PPPD. Method An electronic search was performed of the MEDLINE, EMBASE and PubMed databases to identify all articles related to this topic. Pooled risk ratios (RR) were calculated for categorical outcomes, and mean...
Cited By4
Newest
Tim Hsu-Han Wang1
Estimated H-index: 1
,
Timothy R. Angeli10
Estimated H-index: 10
+ 6 AuthorsGregory O'Grady15
Estimated H-index: 15
Post-surgical gastric dysfunction is common, but the mechanisms are varied and poorly understood. The pylorus normally acts as an electrical barrier isolating gastric and intestinal slow waves. In ...
Published on Mar 1, 2019in Small Ruminant Research1.21
Takenori Onaga13
Estimated H-index: 13
,
Tomohiko Shimoda2
Estimated H-index: 2
+ 2 AuthorsHideaki Hayashi4
Estimated H-index: 4
Abstract The goal of present study was to determine the effects of the intravenous (i.v.) administration of neurotensin (NT) on the ovine forestomach and abomasal motility in conscious sheep. NT injection at 0.3 nmol/kg slightly raised abomasal pressure, although the effect was not dose-dependent. A bolus i.v. injection of NT at 1 or 3 nmol/kg significantly inhibited the amplitude of cyclic ruminal contractions. NT injection did not alter omasal motility. Pre-injection of an NT receptor subtype-...
Published on Oct 1, 2018in JAMA Surgery10.67
Jae Pil Jung1
Estimated H-index: 1
(University of Pittsburgh),
Mazen S. Zenati27
Estimated H-index: 27
(University of Pittsburgh)
+ 4 AuthorsMelissa E. Hogg15
Estimated H-index: 15
(University of Pittsburgh)
Importance Technical proficiency at robotic pancreaticoduodenectomy (RPD) and video assessment are promising tools for understanding postoperative outcomes. Delayed gastric emptying (DGE) remains a major driver of cost and morbidity after pancreaticoduodenectomy. Objective To determine if technical variables during RPD are associated with postoperative DGE. Design, Setting, and Participants A retrospective study was conducted of technical assessment performed in all available videos (n = 192) of...
Published on Aug 1, 2018in Neurogastroenterology and Motility3.80
Katie E. Miller2
Estimated H-index: 2
(Mayo Clinic),
Željko Bajzer14
Estimated H-index: 14
(Mayo Clinic)
+ 9 AuthorsGianrico Farrugia57
Estimated H-index: 57
(Mayo Clinic)
Published on Sep 28, 2017in PLOS ONE2.78
Hilde Løland von Volkmann3
Estimated H-index: 3
(University of Bergen),
Ingeborg Brønstad4
Estimated H-index: 4
(University of Bergen)
+ 7 AuthorsKim Nylund11
Estimated H-index: 11
(Haukeland University Hospital)
Introduction Increased intestinal hydration by activation of the epithelial enzyme linked receptor guanylate cyclase C (GC-C) is a pharmacological principle for treating constipation. Activating mutations in the GUCY2C gene encoding GC-C cause Familial GUCY2C diarrhea syndrome (FGDS) which has been diagnosed with severe dysmotility. Aim To investigate gut motility and hormones before and after a meal in FGDS patients and compare with healthy controls (HC). Subjects and methods Bristol stool char...
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