{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T09:51:33Z","timestamp":1791453093081,"version":"4.3.3"},"reference-count":75,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2021,5,14]],"date-time":"2021-05-14T00:00:00Z","timestamp":1620950400000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"New Zealand Health Research Council and the Royal Australasian College of Surgeons John Mitchell Crouch Fellowship"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Delayed gastric emptying (DGE) is frequent after pancreaticoduodenectomy (PD). Several RCTs have explored operative strategies to minimize DGE, however, the optimal combination of gastric resection approach, anastomotic route, configuration and the use of enteroenterostomy remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>MEDLINE, Embase and CENTRAL databases were systematically searched for RCTs comparing gastric resection (classic Whipple, pylorus-resecting, pylorus-preserving), anastomotic route (antecolic, retrocolic), configuration (loop gastroenterostomy\/Billroth II, Roux-en-Y), and use of enteroenterostomy (Braun). A random-effects, Bayesian network meta-analysis with non-informative priors was conducted to determine the optimal combination of approaches to PD for minimizing DGE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-four RCTs, including 2526 patients and 14 approaches were included. There was some heterogeneity, although inconsistency was low. The overall incidence of DGE was 25.6 per cent (647 patients). Pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy was associated with the lowest rates of DGE and ranked the best in 35 per cent of comparisons. Classic Whipple, retrocolic, Billroth II with Braun ranked the worst for DGE in 32 per cent of comparisons. Pairwise meta-analysis of retrocolic versus antecolic route for gastrojejunostomy found increased risk of DGE with the retrocolic route (odds ratio 2.10, 95 per cent credibility interval (cr.i.) 0.92 to 4.70). Pairwise meta-analysis of enteroenterostomy found a trend towards lower DGE rates when this was used (odds ratio 1.90, 95 per cent cr.i. 0.92 to 3.90). Having a Braun enteroenterostomy ranked the best in 96 per cent of comparisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Based on existing RCT evidence, a pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy seems to be associated with the lowest rates of DGE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Preregistration<\/jats:title>\n                    <jats:p>PROSPERO submitted 23 December 2020. CRD42021227637<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrab035","type":"journal-article","created":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T16:10:55Z","timestamp":1616083855000},"source":"Crossref","is-referenced-by-count":41,"title":["Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7369-8639","authenticated-orcid":false,"given":"C","family":"Varghese","sequence":"first","affiliation":[{"name":"Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland , Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3770-8996","authenticated-orcid":false,"given":"S","family":"Bhat","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland , Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T H -H","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland , Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"O\u2019Grady","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland , Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Pandanaboyana","sequence":"additional","affiliation":[{"name":"HPB and Transplant Unit, Freeman Hospital , Newcastle upon Tyne, UK"},{"name":"Population Health Sciences Institute, Newcastle University , Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,5,14]]},"reference":[{"key":"2023020210113459100_zrab035-B1","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1002\/bjs.7071","article-title":"Evaluation of the International Study Group of Pancreatic Surgery definition of delayed gastric emptying after pancreatoduodenectomy in a high-volume centre","volume":"97","author":"Welsch","year":"2010","journal-title":"Br J Surg"},{"key":"2023020210113459100_zrab035-B2","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1097\/SLA.0b013e3182a6f529","article-title":"Antecolic versus retrocolic route of the gastroenteric anastomosis after pancreatoduodenectomy: a randomized controlled trial","volume":"259","author":"Eshuis","year":"2014","journal-title":"Ann Surg"},{"key":"2023020210113459100_zrab035-B3","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1097\/SLA.0000000000002480","article-title":"Pylorus resection does not reduce delayed gastric emptying after partial pancreatoduodenectomy: a blinded randomized controlled trial (PROPP Study, DRKS00004191)","volume":"267","author":"Hackert","year":"2018","journal-title":"Ann Surg"},{"key":"2023020210113459100_zrab035-B4","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1002\/bjs.11023","article-title":"Randomized trial of two types of gastrojejunostomy after pancreatoduodenectomy and risk of delayed gastric emptying (PAUDA trial)","volume":"106","author":"Busquets","year":"2019","journal-title":"Br J Surg"},{"key":"2023020210113459100_zrab035-B5","article-title":"Influence of the retrocolic versus antecolic route for alimentary tract reconstruction on delayed gastric emptying after pancreatoduodenectomy: a multicenter, noninferiority randomized controlled trial","author":"Toyama","year":"2020","journal-title":"Ann. 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