Evaluation of gastric electrophysiology, symptoms and quality of life after pancreaticoduodenectomy

BackgroundPancreaticoduodenectomy (PD) is an operation performed for several indications, including pancreatic and biliary malignancies. Delayed gastric emptying (DGE) is a common post-operative complication and the underlying pathophysiology remains poorly understood. This study aimed to evaluate the gastric electrophysiology, symptoms and quality of life following PD, using the novel non-invasive Gastric Alimetry System. MethodsPD patients with index operations between 2017-2022 were assessed using the Gastric Alimetry System(R), comprising a stretchable 8x8 electrode array, wearable Reader, and validated symptom logging app. A 30-minute pre-prandial and a 4-hour post-prandial recording was performed. Outcomes included Principal Gastric Frequency, BMI-adjusted amplitude, Gastric Alimetry Rhythm Index, meal response, symptoms, and quality of life (QOL) questionnaires (PAGI-SYM, PAGI-QOL). Data was compared to a validated reference range and matched healthy controls. Results19 patients and 19 matched controls were recruited. There were no differences in any gastric parameters between PD patients and matched controls (all p>0.05). Gastric electrophysiology parameters lay outside normative reference intervals in 8/19 cases, generally being only minor deviations, while significant symptoms occurred in 8/19 (42%); which did not correlate (p=0.43). PD patients had worse quality of life scores than controls (p<0.01), however, no correlations were identified between electrophysiological parameters and QOL. DiscussionModerate to severe upper GI symptoms are common after PD with worse QOL compared to the controls. Gastric electrical activity generally recovers well long-term following PD, indicating that other factors contribute to symptoms. Further studies should now assess acute changes in gastric function after PD.