Is Antisecretory Therapy After Pancreatoduodenectomy Necessary? Meta-analysis and Contemporary Practices of Pancreatic Surgeons

James R. Butler, Tyrone Rogers, George Eckart, Gregory R. Martens, Eugene P. Ceppa, Michael House, Attila Nakeeb, C. Schmidt, Nicholas Zyromski

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)604-612
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume19
Issue number4
DOIs
StatePublished - 2015

Fingerprint

Pancreaticoduodenectomy
Meta-Analysis
Peptic Ulcer
Stomach
Therapeutics
Confidence Intervals
Incidence
Surgeons
Databases
Pylorus
MEDLINE
Prescriptions

Keywords

  • Antisecretory
  • Marginal ulceration
  • Pancreatoduodenectomy
  • Proton pump inhibitors
  • Pylorus preservation

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Is Antisecretory Therapy After Pancreatoduodenectomy Necessary? Meta-analysis and Contemporary Practices of Pancreatic Surgeons. / Butler, James R.; Rogers, Tyrone; Eckart, George; Martens, Gregory R.; Ceppa, Eugene P.; House, Michael; Nakeeb, Attila; Schmidt, C.; Zyromski, Nicholas.

In: Journal of Gastrointestinal Surgery, Vol. 19, No. 4, 2015, p. 604-612.

Research output: Contribution to journalArticle

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title = "Is Antisecretory Therapy After Pancreatoduodenectomy Necessary? Meta-analysis and Contemporary Practices of Pancreatic Surgeons",
abstract = "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.",
keywords = "Antisecretory, Marginal ulceration, Pancreatoduodenectomy, Proton pump inhibitors, Pylorus preservation",
author = "Butler, {James R.} and Tyrone Rogers and George Eckart and Martens, {Gregory R.} and Ceppa, {Eugene P.} and Michael House and Attila Nakeeb and C. Schmidt and Nicholas Zyromski",
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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

AU - Nakeeb, Attila

AU - Schmidt, C.

AU - Zyromski, Nicholas

PY - 2015

Y1 - 2015

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

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