Preventing and Treating Delayed Gastric Emptying (DGE) after Pancreatic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Objective: To identify strategies to prevent and treat delayed gastric emptying (DGE) after pancreatic surgery.

Background: Among all complications of pancreatic surgery, DGE has the largest impact on prolonged hospital stay. Several randomized controlled trials (RCTs) have addressed DGE after pancreatic surgery, either as primary or as secondary outcome.

Methods: RCTs involving pancreatic surgery with DGE as primary or secondary outcome were identified using the online database of the ISGPS Evidence Map of Pancreatic Surgery (2007-2023). Meta-analysis was performed for impact on DGE grade B/C for interventions studied by at least 2 RCTs.

Results: Overall, 152 RCTs were included with 22,260 patients undergoing pancreatic surgery. The overall rate of DGE grade B/C was 11.9%, including 12.7% after pancreatoduodenectomy and 4.2% after left pancreatectomy. No RCT identified an effective treatment of DGE grade B/C. Strategies which reduced the rate of DGE in at least one RCT included: prehabilitation, pancreatico-jejunostomy, antecolic gastrojejunostomy, Billroth II technique, pylorus resection, modified Roux-en-Y technique, no intraperitoneal drainage in left pancreatectomy, minimally invasive left pancreatectomy, minimally invasive pancreatoduodenectomy, mERAS, nasojejunal tube, and early oral feeding. Additional meta-analyses identified minimally-invasive left pancreatectomy as preventive for DGE grade B/C compared to open left pancreatectomy.

Conclusion: This systematic review of RCTs identified 12 strategies which reduced the rate of DGE grade B/C after pancreatic surgery but no effective treatment strategy. Of the 12 preventive strategies, only minimally-invasive left pancreatectomy was confirmed effective in a meta-analysis. Future RCTs should focus on both prevention and treatment of DGE after pancreatic surgery.