J. R. Butler1, T. Rogers1, K. N. Kaneshiro3, G. J. Eckert2, N. J. Zyromski1 1Indiana University School Of Medicine,Department Of Surgery,Indianapolis, IN, USA 2Indiana University School Of Medicine,Biostatistics,Indianapolis, IN, USA 3Indiana University School Of Medicine,Research Library,Indianapolis, IN, USA
Introduction: Marginal ulcer is well-described and serious complication of pancreaticoduodenectomy (PD) whose incidence remains unclear. With the advent of gastric antisecretory medications, surgeons may be able to further mediate the risk of marginal ulceration after PD. Despite this potential, the true relationship between antisecretory medication and marginal ulceration after PD is not precisely known.
Methods: The MEDLINE, EMBASE, Cochrane Central Registrar of Controlled Trials and Cochrane Database of Systematic Reviews databases were searched from their inception to November 2013 for abstracts documenting ulceration after pancreaticoduodenectomy. Two reviewers independently graded abstracts for inclusion in this review. Heterogeneity in combining data was assumed prior to pooling. Random-effects meta-analysis was performed to estimate percentages at 95% confidence intervals.
Results: After a review of 208 abstracts, 65 studies and case series were graded as relevant. These represented a cohort of 209 patients with marginal ulcer after PD. A meta-analysis of studies meeting inclusion criteria shows mean incidence of ulceration after PD of 4.4% with average time to ulceration being 22.2 months post resection. PPPD 3.6%. Classic Cohort 4.8%. Documented use of postoperative antisecretory medication was associated with a reduced rate of 2.1 %.
Conclusion: Although reported incidences of ulceration after PD vary widely across studies, an overall incidence of 4.4% is reported in the literature. This incidence may be demarcated between classic procedures (4.8%) and PPPD procedures (3.6%). Overall median time to ulceration was 22.2 months. Furthermore, the current body of literature reports that the use of prophylactic gastric antisecretory medication after PD is associated with a reduction in ulceration rate by (2.3%).