Gastric decompression and enteral feeding through a double-lumen gastrojejunostomy tube improves outcomes after pancreaticoduodenectomy

Lloyd A. Mack, Ioannis G. Kaklamanos, Alan Livingstone, Joe Levi, Carolyn Robinson, Danny Sleeman, Dido Franceschi, Oliver F. Bathe

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Objective: The objective of this study was to assess the feasibility and safety of inserting a double-lumen gastrojejunostomy tube (GJT) after pancreaticoduodenectomy (PD) and to evaluate associated outcomes. Background: Gastroparesis is a frequent postoperative event following PD. This often necessitates prolonged gastric decompression and nutritional support. A double-lumen GJT may be particularly useful in this situation: gastric decompression may be achieved through the gastric port without a nasogastric tube; enteral feeding may be administered through the jejunal port. Methods: Thirty-six patients with periampullary tumors were randomized at the time of PD to insertion of GJT or to the routine care of the operating surgeon. Outcomes, including length of stay, complications, and costs, were followed prospectively. Results: The 2 groups had similar characteristics. Prolonged gastroparesis occurred in 4 controls (25%) and in none of the patients who had a GJT (P = 0.03). Complication rates were similar in each group. Mean postoperative length of stay was significantly longer in controls compared with patients who had a GJT (15.8 ± 7.8 days versus 11.5 ± 2.9 days, respectively; P = 0.01). Hospital charges were $82,151 ± 56,632 in controls and $52,589 ± 15,964 in the GJT group (P = 0.036). Conclusions: In patients undergoing PD, insertion of a GJT is safe. Moreover, insertion of a GJT improves average length of stay. At the time of resection of periampullary tumors, GJT insertion should be considered, especially given this is a patient population in which weight loss and cachexia are frequent.

Original languageEnglish
Pages (from-to)845-851
Number of pages7
JournalAnnals of Surgery
Volume240
Issue number5
DOIs
StatePublished - Nov 1 2004

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Pancreaticoduodenectomy
Gastric Bypass
Enteral Nutrition
Decompression
Stomach
Gastroparesis
Length of Stay
Hospital Charges
Cachexia
Nutritional Support
Weight Loss
Neoplasms
Safety
Costs and Cost Analysis

ASJC Scopus subject areas

  • Surgery

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Gastric decompression and enteral feeding through a double-lumen gastrojejunostomy tube improves outcomes after pancreaticoduodenectomy. / Mack, Lloyd A.; Kaklamanos, Ioannis G.; Livingstone, Alan; Levi, Joe; Robinson, Carolyn; Sleeman, Danny; Franceschi, Dido; Bathe, Oliver F.

In: Annals of Surgery, Vol. 240, No. 5, 01.11.2004, p. 845-851.

Research output: Contribution to journalArticle

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abstract = "Objective: The objective of this study was to assess the feasibility and safety of inserting a double-lumen gastrojejunostomy tube (GJT) after pancreaticoduodenectomy (PD) and to evaluate associated outcomes. Background: Gastroparesis is a frequent postoperative event following PD. This often necessitates prolonged gastric decompression and nutritional support. A double-lumen GJT may be particularly useful in this situation: gastric decompression may be achieved through the gastric port without a nasogastric tube; enteral feeding may be administered through the jejunal port. Methods: Thirty-six patients with periampullary tumors were randomized at the time of PD to insertion of GJT or to the routine care of the operating surgeon. Outcomes, including length of stay, complications, and costs, were followed prospectively. Results: The 2 groups had similar characteristics. Prolonged gastroparesis occurred in 4 controls (25{\%}) and in none of the patients who had a GJT (P = 0.03). Complication rates were similar in each group. Mean postoperative length of stay was significantly longer in controls compared with patients who had a GJT (15.8 ± 7.8 days versus 11.5 ± 2.9 days, respectively; P = 0.01). Hospital charges were $82,151 ± 56,632 in controls and $52,589 ± 15,964 in the GJT group (P = 0.036). Conclusions: In patients undergoing PD, insertion of a GJT is safe. Moreover, insertion of a GJT improves average length of stay. At the time of resection of periampullary tumors, GJT insertion should be considered, especially given this is a patient population in which weight loss and cachexia are frequent.",
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AU - Kaklamanos, Ioannis G.

AU - Livingstone, Alan

AU - Levi, Joe

AU - Robinson, Carolyn

AU - Sleeman, Danny

AU - Franceschi, Dido

AU - Bathe, Oliver F.

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N2 - Objective: The objective of this study was to assess the feasibility and safety of inserting a double-lumen gastrojejunostomy tube (GJT) after pancreaticoduodenectomy (PD) and to evaluate associated outcomes. Background: Gastroparesis is a frequent postoperative event following PD. This often necessitates prolonged gastric decompression and nutritional support. A double-lumen GJT may be particularly useful in this situation: gastric decompression may be achieved through the gastric port without a nasogastric tube; enteral feeding may be administered through the jejunal port. Methods: Thirty-six patients with periampullary tumors were randomized at the time of PD to insertion of GJT or to the routine care of the operating surgeon. Outcomes, including length of stay, complications, and costs, were followed prospectively. Results: The 2 groups had similar characteristics. Prolonged gastroparesis occurred in 4 controls (25%) and in none of the patients who had a GJT (P = 0.03). Complication rates were similar in each group. Mean postoperative length of stay was significantly longer in controls compared with patients who had a GJT (15.8 ± 7.8 days versus 11.5 ± 2.9 days, respectively; P = 0.01). Hospital charges were $82,151 ± 56,632 in controls and $52,589 ± 15,964 in the GJT group (P = 0.036). Conclusions: In patients undergoing PD, insertion of a GJT is safe. Moreover, insertion of a GJT improves average length of stay. At the time of resection of periampullary tumors, GJT insertion should be considered, especially given this is a patient population in which weight loss and cachexia are frequent.

AB - Objective: The objective of this study was to assess the feasibility and safety of inserting a double-lumen gastrojejunostomy tube (GJT) after pancreaticoduodenectomy (PD) and to evaluate associated outcomes. Background: Gastroparesis is a frequent postoperative event following PD. This often necessitates prolonged gastric decompression and nutritional support. A double-lumen GJT may be particularly useful in this situation: gastric decompression may be achieved through the gastric port without a nasogastric tube; enteral feeding may be administered through the jejunal port. Methods: Thirty-six patients with periampullary tumors were randomized at the time of PD to insertion of GJT or to the routine care of the operating surgeon. Outcomes, including length of stay, complications, and costs, were followed prospectively. Results: The 2 groups had similar characteristics. Prolonged gastroparesis occurred in 4 controls (25%) and in none of the patients who had a GJT (P = 0.03). Complication rates were similar in each group. Mean postoperative length of stay was significantly longer in controls compared with patients who had a GJT (15.8 ± 7.8 days versus 11.5 ± 2.9 days, respectively; P = 0.01). Hospital charges were $82,151 ± 56,632 in controls and $52,589 ± 15,964 in the GJT group (P = 0.036). Conclusions: In patients undergoing PD, insertion of a GJT is safe. Moreover, insertion of a GJT improves average length of stay. At the time of resection of periampullary tumors, GJT insertion should be considered, especially given this is a patient population in which weight loss and cachexia are frequent.

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