Impact of Side-to-Side Versus End-to-Side Gastrojejunostomy on the Rate of Delayed Gastric Emptying After Pancreatoduodenectomy (IPAD study): A Randomized Controlled Trial.
Fabien Robin, Edouard Wasielewski, Mohamed A Chaouch et al.
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In 30 seconds
The IPAD study was a prospective, open-label randomized trial at two high-volume pancreatic centers in France, comparing side-to-side with end-to-side gastrojejunostomy in adults undergoing pancreatoduodenectomy for benign or malignant disease. Among 158 randomized patients, delayed gastric emptying occurred in 38.0% after side-to-side and 30.4% after end-to-side reconstruction (risk ratio 1.25; 95% CI: 0.81-1.94; P =0.314). The trial found no significant difference in delayed gastric emptying or in reported postoperative outcomes, nutritional measures, or 90-day quality of life.
Key findings
- Delayed gastric emptying occurred in 38.0% after side-to-side versus 30.4% after end-to-side gastrojejunostomy (risk ratio 1.25; 95% CI: 0.81-1.94; P =0.314).
- Pancreatic fistula, biliary fistula, reintervention, and mortality rates were similar between groups.
- At 90 days, GIQLI scores were 87.9 versus 86.6 (P =0.68), with no difference in nutritional parameters.
Why it matters
Delayed gastric emptying is a frequent complication after pancreatoduodenectomy and can prolong recovery. This randomized comparison addresses whether gastrojejunostomy configuration affects that outcome. The findings do not show a significant advantage for either technique, and the similar reported secondary outcomes provide useful comparative evidence when considering reconstruction options.
What to keep in mind
The trial was open-label and conducted at two high-volume centers in France, which may limit generalizability. The reported comparison did not demonstrate a significant difference in delayed gastric emptying.