Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors

Objectives: This study evaluates the incidence and clinical features and associated risk factors of delayed gastric emptying (DGE) after pancreaticoduodenectomy, employing the International Study Group of Pancreatic Surgery (ISGPS) consensus definition. Methods: Demographic, pathological and surgical details for 260 consecutive patients who underwent pylorus-preserving pancreaticoduodenectomy at a single institution were analysed using univariate and multivariate models. Results: Postoperative complications occurred in 108 (41.5%) and DGE was diagnosed in 36 (13.8%) of 260 patients. Among the 36 DGE patients, 16 had grade A, 18 grade B and two grade C DGE. Resumption of a solid diet (P < 0.001), time to passage of stool (P = 0.002) and hospital discharge (P < 0.001) occurred later in DGE patients. The need for total parenteral nutrition was significantly higher in DGE grade B/C patients (P < 0.001). In the univariate analysis, abdominal collections (P <= 0.001), pancreatic fistula (PF) grades B and C (P < 0.001), biliary fistula (P = 0.002), pulmonary complications (P < 0.001) and sepsis (P = 0.002) were associated with DGE. Only abdominal collections (P = 0.009), PF grade B/C (P < 0.001) and sepsis (P = 0.024) were associated with clinically relevant DGE. In the multivariate analysis, PF grade B/C (P = 0.004) and biliary fistula (P = 0.039) were independent risk factors for DGE. Conclusions: The ISGPS classification and grading systems correlate well with the clinical course of DGE and are feasible for patient management. The principal risk factors for DGE seem to be pancreatic and biliary fistulas.