TY - JOUR
T1 - Is Antisecretory Therapy After Pancreatoduodenectomy Necessary? Meta-analysis and Contemporary Practices of Pancreatic Surgeons
AU - Butler, James R.
AU - Rogers, Tyrone
AU - Eckart, George
AU - Martens, Gregory R.
AU - Ceppa, Eugene P.
AU - House, Michael G.
AU - Nakeeb, Attila
AU - Schmidt, C. Max
AU - Zyromski, Nicholas J.
N1 - Publisher Copyright:
© 2015, The Society for Surgery of the Alimentary Tract.
PY - 2015/4
Y1 - 2015/4
N2 - Background: Marginal ulcer (MU) is a well-described complication of pancreatoduodenectomy (PD) whose incidence remains unclear. Gastric antisecretory medications likely attenuate the risk of marginal ulceration after PD; however, the true relationship between antisecretory medication and marginal ulceration after PD is not precisely known. The aims of this study were to document the incidence of MU after PD, identify any relationship between MU and gastric antisecretory medication, and survey current practice of MU prophylaxis among experienced pancreatic surgeons. Methods: the MEDLINE, EMBASE, Cochrane Central Registrar of Controlled Trials, and Cochrane Database of Systematic Reviews databases were searched from their inception to May 2014 for abstracts documenting ulceration after pancreatoduodenectomy. Two reviewers independently graded abstracts for inclusion in this review. Contemporary practice was assessed through a four-question survey distributed globally to 200 established pancreatic surgeons. Results: After a review of 208 abstracts, 54 studies were graded as relevant. These represented a cohort of 212 patients with marginal ulcer after PD (n = 4794). A meta-analysis of the included references shows mean incidence of ulceration after PD of 2.5 % (confidence interval (CI) 1.8–3.2 %) with a median time to diagnosis of 15.5 months. Pylorus preservation was associated with a MU rate of 2.0 % (CI 1.0–2.9 %), while “classic” PD procedures report an overall rate of 2.6 % (CI 1.6–3.6 %). Documented use of postoperative antisecretory medication was associated with a reduced rate of 1.4 % (CI 0.1–1.7 %). One hundred forty-four of 200 (72 %) surveys were returned, from which it was determined that 92 % of pancreatic surgeons have dealt with this complication, and 86 % routinely prescribe prophylactic antisecretory medication after PD. Conclusions: The incidence of MU after PD is 2.5 % with a median time to occurrence of 15.5 months postoperatively. Gastric antisecretory medication prescription may affect the incidence of MU. The majority of pancreatic surgeons surveyed have encountered MU after PD; most (86 %) routinely prescribe prophylactic gastric antisecretory medication.
AB - Background: Marginal ulcer (MU) is a well-described complication of pancreatoduodenectomy (PD) whose incidence remains unclear. Gastric antisecretory medications likely attenuate the risk of marginal ulceration after PD; however, the true relationship between antisecretory medication and marginal ulceration after PD is not precisely known. The aims of this study were to document the incidence of MU after PD, identify any relationship between MU and gastric antisecretory medication, and survey current practice of MU prophylaxis among experienced pancreatic surgeons. Methods: the MEDLINE, EMBASE, Cochrane Central Registrar of Controlled Trials, and Cochrane Database of Systematic Reviews databases were searched from their inception to May 2014 for abstracts documenting ulceration after pancreatoduodenectomy. Two reviewers independently graded abstracts for inclusion in this review. Contemporary practice was assessed through a four-question survey distributed globally to 200 established pancreatic surgeons. Results: After a review of 208 abstracts, 54 studies were graded as relevant. These represented a cohort of 212 patients with marginal ulcer after PD (n = 4794). A meta-analysis of the included references shows mean incidence of ulceration after PD of 2.5 % (confidence interval (CI) 1.8–3.2 %) with a median time to diagnosis of 15.5 months. Pylorus preservation was associated with a MU rate of 2.0 % (CI 1.0–2.9 %), while “classic” PD procedures report an overall rate of 2.6 % (CI 1.6–3.6 %). Documented use of postoperative antisecretory medication was associated with a reduced rate of 1.4 % (CI 0.1–1.7 %). One hundred forty-four of 200 (72 %) surveys were returned, from which it was determined that 92 % of pancreatic surgeons have dealt with this complication, and 86 % routinely prescribe prophylactic antisecretory medication after PD. Conclusions: The incidence of MU after PD is 2.5 % with a median time to occurrence of 15.5 months postoperatively. Gastric antisecretory medication prescription may affect the incidence of MU. The majority of pancreatic surgeons surveyed have encountered MU after PD; most (86 %) routinely prescribe prophylactic gastric antisecretory medication.
KW - Antisecretory
KW - Marginal ulceration
KW - Pancreatoduodenectomy
KW - Proton pump inhibitors
KW - Pylorus preservation
UR - http://www.scopus.com/inward/record.url?scp=84925467143&partnerID=8YFLogxK
U2 - 10.1007/s11605-015-2765-8
DO - 10.1007/s11605-015-2765-8
M3 - Article
C2 - 25691111
AN - SCOPUS:84925467143
SN - 1091-255X
VL - 19
SP - 604
EP - 612
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 4
ER -