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Does the Ileal Brake Contribute to Delayed Gastric Emptying After Pancreatoduodenectomy

Published on Feb 1, 2017in Digestive Diseases and Sciences2.937
· DOI :10.1007/s10620-016-4402-0
Savio G. Barreto15
Estimated H-index: 15
(Flinders Medical Centre),
John A. Windsor52
Estimated H-index: 52
(University of Auckland)
Sources
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 (160)
  • Citations (6)
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References160
Newest
#1Qi-Yu LiuH-Index: 2
#2Li LiH-Index: 1
Last. Shichun Lu (Chinese PLA General Hospital)H-Index: 3
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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 ...
8 CitationsSource
#1Mena M. Hanna (UM: University of Miami)H-Index: 7
#2Rahul Gadde (UM: University of Miami)H-Index: 7
Last. Danny YakoubH-Index: 9
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2 CitationsSource
#1Jamie R. Robinson (Vandy: Vanderbilt University)H-Index: 8
#2Paula Marincola (Vandy: Vanderbilt University)H-Index: 2
Last. Aj Parikh (Vandy: Vanderbilt University)H-Index: 37
view all 6 authors...
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...
11 CitationsSource
#1Bin Xu (Tongji University)H-Index: 1
#2Hongbo Meng (Tongji University)H-Index: 9
Last. Zhenshun Song (Tongji University)H-Index: 14
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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 ...
15 CitationsSource
#1T. CourvoisierH-Index: 2
#2Gianluca DonatiniH-Index: 2
Last. Jean Pierre RicherH-Index: 12
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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...
7 CitationsSource
#1Mena M. Hanna (UM: University of Miami)H-Index: 7
#2Rahul Gadde (UM: University of Miami)H-Index: 7
Last. Danny Yakoub (UM: University of Miami)H-Index: 9
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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).
15 CitationsSource
#1John L. Cameron (Johns Hopkins University)H-Index: 118
#2Jin He (Johns Hopkins University)H-Index: 24
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...
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#1Ayman El Nakeeb (Mansoura University)H-Index: 18
#2Waleed Askr (Mansoura University)H-Index: 5
Last. Mohamed Abd ElWahab (Mansoura University)H-Index: 5
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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.
17 CitationsSource
#1Richard H. BellH-Index: 36
Last. Andrew M. Smith (Auckland City Hospital)H-Index: 1
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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...
11 CitationsSource
#1Adarsh ChaudharyH-Index: 17
#2Savio G. BarretoH-Index: 15
Last. Tanveer SinghH-Index: 3
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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
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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-...
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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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