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

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 dollars in controls and 52,589 +/- 15,964 dollars 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.

FIGURE 1. Box plot depicting operative times. The upper and lower lines comprising each box represent the 75th and 25th percentiles, respectively. The line in the middle of the box represents the median operative time.

FIGURE 2. Kaplan-Meier curve illustrating postoperative length of stay.