Impact of Side-to-Side Versus End-to-Side Gastrojejunostomy on the Rate of Delayed Gastric Emptying After Pancreatoduodenectomy (IPAD study)

Objective: To evaluate whether side-to-side gastrojejunostomy (SSGJ) reduces delayed gastric emptying (DGE) compared with end-to-side gastrojejunostomy (ESGJ) after pancreatoduodenectomy (PD). Summary Background Data: DGE is one of the most frequent complications after PD, leading to prolonged recovery and increased morbidity. Retrospective studies have suggested that the configuration of the gastrojejunostomy may influence DGE, but no randomized trial has confirmed this. Methods: The IPAD study was a prospective, randomized, open-label trial conducted at 2 high-volume pancreatic centers in France. Adult patients undergoing PD for benign or malignant disease were randomized intraoperatively (1:1) to SSGJ or ESGJ and followed for 90 days. The primary endpoint was the incidence of DGE. Secondary endpoints included postoperative complications, nutritional outcomes, and quality of life (QoL) assessed at 90 days using the GastroIntestinal Quality of Life Index (GIQLI). Results: From May 1, 2021 to July 1, 2023, among 171 screened patients, 158 were randomized (79 per group). Baseline characteristics were comparable except for sex distribution and rates of hypertension and chronic obstructive pulmonary disease. DGE occurred in 38.0% of patients after SSGJ and 30.4% after ESGJ (risk ratio 1.25; 95% CI: 0.81–1.94; P =0.314). Rates of pancreatic fistula, biliary fistula, reintervention, and mortality were similar. At 90 days, nutritional parameters and GIQLI scores (87.9 vs. 86.6; P =0.68) did not differ between groups. Conclusions: The present RCT found no significant difference in the rate of DGE between SSGJ and ESGJ. Postoperative outcomes, nutritional status, and quality of life were comparable, indicating that both techniques yielded comparable outcomes.