OBJECTIVETo explore the risk factors of delayed gastric emptying after gastrectomy.

METHODSMeta-analysis was performed to screen risk factors of delayed gastric emptying after gastrectomy based on 19 associated articles published from 2003 to 2013.

RESULTSGender, operative time, blood loss during operation, surgical settings(emergency, elective surgery), radical surgery were not significantly different between two groups for delayed gastric emptying (all P>0.05). Age more than or equal to 60 years [combined odds ratio(OR)=1.65, 95% confidence interval(CI):1.31-2.09, P<0.01], preoperative gastrointestinal obstruction(combined OR=3.72, 95%CI:3.05-4.55, P<0.01), Billroth-II( (combined OR=3.35, 95%CI:2.72-4.13, P<0.01), anemia(combined OR=1.48, 95%CI:1.08-2.02, P=0.01), intra-abdominal complication (combined OR=2.41, 95%CI:1.77-3.29, P<0.01), perioperative blood glucose greater than 8 mmol/L(combined OR=2.64, 95%CI:2.00-3.49, P<0.01), postoperative albumin levels lower than 30 g/L (combined OR=2.13, 95%CI:1.62-2.79, P<0.01), use of analgesics pump after operation (combined OR=1.74, 95%CI:1.33-2.26, P<0.01), having adverse psychological reactions (combined OR=5.94, 95%CI:1.79-19.73, P=0.004) were risk factors affecting delayed gastric emptying.

CONCLUSIONAge more than or equal to 60, preoperative gastrointestinal obstruction, perioperative blood glucose greater than or equal to 8 mmol/L, postoperative albumin levels less than 30 g/L, Billroth-II(, anemia, intra-abdominal complication, using pain pump after operation, having adverse psychological reactions are risk factors affecting delayed gastric emptying after gastrectomy.

Gastrectomy ; adverse effects ; Gastroenterostomy ; Gastroparesis ; etiology ; Humans ; Risk Factors

Acupuncture Therapy ; Adult ; Burns ; complications ; Female ; Gastroparesis ; etiology ; therapy ; Humans

OBJECTIVETo investigate the causes, diagnosis and treatment of gastroparesis syndrome after nongastrectomy abdominal operation.

METHODSThe clinical data of 22 cases with gastroparesis syndrome after nongastrectomy abdominal operation from 1972 to 2004 were retrospectively analyzed.

RESULTSGastroparesis syndrome after nongastrectomy abdominal operation often occurred during 4-6 days postoperatively when the patients began to take in food, characterized by upper abdominal distension, nausea, vomiting, strong splashing bowel sound, weak bowel sound and large quantity of gastric drainage ranging from 1000 to 3000 ml every day. Barium meal was valuable not only in the diagnosis but also effective for promoting gas motility. It revealed a non-peristaltic, flabby and static stomach, and retention of contrast medium in the stomach even 5-6 hours later. All the patients recovered through non-operative therapy for 5-25 days including continuous gastrointestinal decompression, TPN and gastro-intestinal dynamic medicine.

CONCLUSIONSThe causes of gastroparesis syndrome after nongastrectomy abdominal operation are multifactorial, most of such patients can be cured by non-operative therapy.

Abdominal Cavity ; surgery ; Adult ; Aged ; Female ; Gastroparesis ; diagnosis ; etiology ; therapy ; Humans ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo investigate the prevention and treatment for postsurgical gastroparesis syndrome (PGS) after pancreaticoduodenectomy.

METHODSThe data of 18 PGS cases after pancreaticoduodenectomy were analyzed.

RESULTSPGS of these 18 patients occurred within 4-10 days after operation. All of the PGS patients were cured with mean 25.4 days by conservative therapy and no one received re-operation. PGS was closely associated with the operation procedure (chi(2)=3.90, P<0.05)and postoperative complications (chi(2)=3.92, P<0.05).

CONCLUSIONSIncidence of PGS can be decreased by improvement of surgical procedure and prevention of abdominal complications. PGS can be cured by conservative therapy generally. Re-operation should be avoided.

Adult ; Aged ; Female ; Gastroparesis ; etiology ; Humans ; Male ; Middle Aged ; Pancreaticoduodenectomy ; adverse effects ; Postoperative Complications

Duchenne's muscular dystrophy (DMD) is an X-linked recessive disease. Clinical descriptions of the disorder focus principally on skeletal muscle degeneration. Another manifestation, which involves the gastrointestinal tract, may be fatal. But its prevalence remains undefined. We report here a case of acute gastroparesis associated with Duchenne's muscular dystrophy. In our case, the patient's symptoms were improved by prokinetic agents and timely decompression in life-threatening acute gastric dilatation.
Acute Disease ; Adolescence ; Case Report ; Contrast Media ; Decompression ; Gastric Emptying/physiology ; Gastrointestinal Agents/therapeutic use ; Gastrointestinal Motility/drug effects ; Gastroparesis/radiography ; Gastroparesis/physiopathology ; Gastroparesis/etiology* ; Human ; Male ; Muscular Dystrophies/complications* ; Radiography, Abdominal

OBJECTIVE: To observe the effect of electroacupuncture (EA) at "Zusanli" (ST 36) combined with mosapride on gastric emptying rate and gastric motility in the rats with diabetic gastroparesis. METHODS: Using random number table method, 68 male SD rats were divided into a blank group (12 rats) and a model establishment group (56 rats). In the model establishment group, the models of diabetic gastroparesis were established with intraperitoneal injection of streptozotocin combined with high-fat and high-sugar diet. Six weeks later, the successful rat models in the model establishment group were randomized into a model group, an EA group, a mosapride group and a combined treatment group, 12 rats in each one. In the EA group, EA was exerted at "Zusanli" (ST 36) (disperse-dense wave, 2 Hz/15 Hz in frequency, 2 mA in intensity) for 20 min. In the mosapride group, mosapride was intervened with intragastric administration (2 mg/kg). In the combined treatment group, electroacupuncture at "Zusanli" (ST 36) was combined with intragastric administration of mosapride. The intervention was given once daily in each group. There was 1 day at interval after 6-day intervention, consecutively for 5 weeks. At the end of intervention, the random blood glucose, gastric emptying rate and the data of gastric motility (average intra-gastric pressure, amplitude and frequency of gastric motility) were detected. RESULTS: Compared with the blank group, blood glucose was increased in the model group (P<0.001). Blood glucose was reduced in the EA group, the mosapride group and the combined treatment group as compared with the model group separately (P<0.001, P<0.01), whereas, compared with the mosapride group, blood glucose was decreased in the combined treatment group (P<0.05). In comparison with the blank group, the gastric emptying rate, the average intra-gastric pressure and the amplitude of gastric motility were all decreased in the model group (P<0.001) and the frequency of gastric motility was increased (P<0.001). Gastric emptying rate, the average intra-gastric pressure and the amplitude of gastric motility were increased in the EA group, the mosapride group and the combined treatment group (P<0.01, P<0.05, P<0.001) and the frequency of gastric motility was decreased (P<0.001) as compared with the model group respectively. Compared with the EA group, the average intra-gastric pressure and the amplitude of gastric motility were increased in the combined treatment group (P<0.001). In comparison with the mosapride group, the gastric emptying rate, the average intra-gastric pressure, the amplitude and frequency of gastric motility in the combined treatment group, as well as the frequency of gastric motility in the EA group were all increased (P<0.05, P<0.001, P<0.01). CONCLUSION Electroacupuncture at "Zusanli" (ST 36) combined with intragastric administration of mosapride could regulate blood glucose and improve the gastric motility in the rats with diabetic gastroparesis. The effect is better than either simple electroacupuncture or mosapride.
Acupuncture Points ; Animals ; Benzamides ; Diabetes Mellitus/therapy* ; Electroacupuncture ; Gastrointestinal Motility/physiology* ; Gastroparesis/etiology* ; Male ; Morpholines ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo explore the clinical significance of improvement gastrostomy in pancreaticoduodenectomy.

METHODSClinical data of 82 patients who underwent pancreaticoduodenectomy and jejunostomy from November 2004 to December 2006 were collected, among which 36 patients received improvement gastrostomy (treatment group), 24 patients accepted traditionary gastrostomy (control group 1) and 22 patients without any gastrostomy (control group 2). Operative time, postoperative duration of gastrointestinal decompression tube, postoperative gastroparesis, pancreatic fistula, biliary fistula, and abdominal cavity infection were compared.

RESULTSThe incidence of postoperative gastroparesis in the treatment group and control group 2 were can significantly lower than that in the control group 1 (P < 0.05). The postoperative duration of gastrointestinal decompression tube of the treatment group was significant shorter than that of control group 2 (P < 0.01). There were no significant difference in other items.

CONCLUSIONSThe improvement gastrostomy in pancreaticoduodenectomy is simple and secure. It can significantly shorten the postoperative duration of gastrointestinal decompression tube and also obviously reduce the incidence of postoperative gastroparesis compared with traditionary gastrostomy.

Adult ; Aged ; Female ; Gastroparesis ; etiology ; prevention & control ; Gastrostomy ; methods ; Humans ; Male ; Middle Aged ; Pancreaticoduodenectomy ; adverse effects ; methods ; Postoperative Complications ; etiology ; prevention & control ; Treatment Outcome

No abstract available.
Aged ; Chronic Disease ; Female ; Gastroparesis/complications/*diagnosis/radiography ; Gastroscopy ; Hernia, Diaphragmatic/complications/*diagnosis ; Humans ; Stomach Volvulus/*diagnosis/etiology/surgery ; Tomography, X-Ray Computed

OBJECTIVETo investigate the risk factors of postsurgical gastroparesis syndrome (PGS) after subtotal gastrectomy in gastric cancer and the impact of PGS on prognosis.

METHODSClinical data of 422 patients who underwent subtotal gastrectomy for gastric cancer in the Central Hospital of Huzhou Sity from January 2004 to May 2010 were analyzed retrospectively. Risk factors of PGS were indentified and the recurrence-free survival was compared between the patients with and without PGS.

RESULTSPGS occurred in 42 patients (9.5%). Univariate analysis showed that: age over 65, combination of anxiety disorder, low-albuminemia in perioperative period, pyloric obstruction in preoperative period, high serume glucose level (≥ 11.2 mmol/L) in postoperative period, Billroth II (gastroenterostomy, operation time over 4 hours, using patient-controlled analgesia, or intravenous fluid over 3500 ml/d (all P<0.05) were prone to develop PGS. These might be potential clinical risk factors associated to PGS. Correlation analysis showed the number of clinical risk factors was positively correlated with the incidence of PGS (r=0.967, P<0.05). A total of 215 cases (50.9%) were followed up for 3-60 months. The mean recurrence-free survival time of patients with PGS was 26.1 months, which was shorter than that of those without PGS (33.4 months, P=0.029).

CONCLUSIONSGastric cancer patients with the clinical risk factors mentioned above are prone to develop PGS after subtotal gastrectomy. PGS is associated with poor prognosis.

Adult ; Aged ; Aged, 80 and over ; Female ; Gastrectomy ; adverse effects ; methods ; Gastroparesis ; etiology ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; surgery ; Young Adult

OBJECTIVE: To establish a modified endoscopic Freka Trelumina placement (mEFTP) for modifying or substituting the traditional endoscopic Freka Trelumina placement (EFTP) and to explore the safety and feasibility of mEFTP in patients requiring enteral nutrition and gastrointestinal decompression in general surgery. METHODS: A retrospective cohort study was conducted to analyze the clinical data of patients undergoing EFTP or mEFTP at General Surgery Department of 920 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January 2016 to January 2018. INCLUSION CRITERIA: the function of lower digestive tract was normal; patients who could not eat through mouth or nasogastric tube needed to have enteral nutrition and gastrointestinal decompression; the retention time of Freka Trelumina (FT) was not expected to exceed 2 months. EXCLUSION CRITERIA: contraindication for gastroscopy; suspected shock or digestive tract perforation; suspected mental diseases; infectious diseases of digestive tract; thoracoabdominal aortic aneurysm. mEFIP procedure was as follow. FT was inserted into stomach through one side nasal cavity, gastroscope was inserted into stomach cavity, and the front part of FT was clamped with biopsy forceps through biopsy hole. Biopsy forceps and FT were inserted into the pylorus or anastomosis under gastroscope, and they were pushed into the duodenum or output loop. During pushing, the gastroscope did not pass through the duodenum or output loop. The biopsy forceps was released and pushed out, and FT was pushed with biopsy forceps synchronously into the duodenum or output loop more than 5 cm. The foreign body forceps was inserted through the biopsy hole, and the FT tube was held in the stomach and pushed to the duodenum or output loop. The previous steps repeated until the suction cavity reached the pylorus or anastomosis. The gastroscope was exited gently; the guide wire was pulled out slowly. EFTP procedure: foreign body forceps was used to clamp the front part of FT, and gastroscope, foreign body forceps and FT pass the pylorus or anastomosis simultaneously to reach the descendent duodenum or output loop as a whole. The time of catheterization was recorded and position of FT was examined by X-ray within 1 h after catheterization. The success rate of catheterization and morbidity of complications after catheterization were evaluated and compared between the two groups. RESULTS: A total of 141 patients were enrolled, 72 in the mEFTP group and 69 in the EFTP group. In mEFTP group, 45 cases were males and 27 were females with an average age of 55.8(37-76) years; 27 cases had normal upper gastrointestinal anatomy (postoperative gastroplegia syndrome due to colon cancer in 17 cases, due to rectal cancer in 10 cases) and 45 had upper gastrointestinal anatomic changes (gastric cancer with pylorus obstruction in 18 cases and anastomotic block after gastroenterostomy in 27 cases). In the EFTP group, 41 were males and 28 were females with an average age of 55.3(36-79) years; 33 cases had normal upper gastrointestinal anatomy (postoperative gastroplegia syndrome due to colon cancer in 20 cases, due to rectal cancer in 13 cases) and 36 had upper gastrointestinal anatomic changes (gastric cancer with pylorus obstruction in 15 cases and anastomotic block after gastroenterostomy in 21 cases). In patients with normal upper digestive tract anatomy, the average catheterization time of mEFTP was (4.9±1.7) minutes which was shorter than (7.6±1.7) minutes of EFTP(t=6.683, P<0.001). In patients of gastric cancer with pyloric obstruction, the average catheterization time of mEFTP was (6.6±1.6) minutes which was shorter than (10.5±2.6) minutes of EFTP (t=4.724, P<0.001). In patients with anastomotic block after gastroenterostomy, the average catheterization time of mEFTP was (11.3±2.5) minutes which was shorter than (15.1±3.5) minutes of EFTP (t=4.513, P<0.001). In patients with normal upper gastrointestinal anatomy, there were no significant differences in the success rate of catheterization and the morbidity of catheterization complication between mEFTP and EFTP (all P>0.05). In patients with upper gastrointestinal anatomic changes, the success rate of catheterization in mEFTP was even higher than that in EFTP, but the difference was not significant [97.8%(41/45) vs. 86.1%(31/36), χ²=2.880, P=0.089]; while the morbidity of catheterization complication in mEFTP was lower than that in EFTP [0 vs. 8.3%(3/36), χ²=3.894, P=0.048]. CONCLUSIONS Whether the upper gastrointestinal anatomy is normal or not, mEFTP presents shorter catheterization time, higher success catheterization rate than EFTP, and is safety. mEFTP can be widely applied to clinical practice for patients requiring enteral nutrition and gastrointestinal decompression.
Adult ; Aged ; Decompression, Surgical ; instrumentation ; methods ; Enteral Nutrition ; instrumentation ; methods ; Female ; Gastric Outlet Obstruction ; etiology ; surgery ; Gastroparesis ; etiology ; surgery ; Gastroscopy ; instrumentation ; methods ; Humans ; Intubation, Gastrointestinal ; instrumentation ; methods ; Male ; Middle Aged ; Retrospective Studies ; Stomach Diseases ; etiology ; surgery