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Is Antacid Therapy After Pancreatoduodenectomy Necessary? Contemporary Global Practice of Pancreatic Surgeons
James R. Butler*, Eugene P. Ceppa, Michael G. House, Attila Nakeeb, C. Max Schmidt, Nicholas J. Zyromski
Surgery, Indiana University School of Medicine, Indianapolis, IN
Background: Marginal ulcer is a well-described and morbid complication of pancreatoduodenectomy (PD). As increasing numbers of PD are performed for non-oncologic indications, this often-delayed complication may be more prevalent. Effective acid suppressing medication may mediate the risk of marginal ulceration after PD. However, few data exist regarding the true incidence of marginal ulcer after PD, and ulcer prophylaxis is not standardized. The aim of this study was to document the current practice of gastric antisecretory medication prescription after PD among experienced pancreatic surgeons.
Methods: A four-question survey was distributed electronically to established pancreatic surgeons across the world. The questions asked: 1. How many years have you practiced pancreatic surgery; how many PD have you performed? 2. Do you currently prescribe antacid medication for post-op PD patients and if so for what duration? 3. Has your practice of post-PD antacid prescription changed over your career, if so why? 4. Have you ever treated a patient with a marginal ulcer after PD?
Results: 145 of 200 (73%) surveys were returned, representing 11 countries and a collective experience of over 55,000 PD. Among respondents, the average number of years practicing pancreatic surgery was 15 (rage 2-40) and the average number of PD preformed was 425 (range 23-2000). Most pancreatic surgeons (86%) prescribe antacid medication after resection. The duration of antacid treatment was variable: 16% limited treatment to the immediate postoperative period (approximately 7 days), 38% prescribed antacids for 1-12 months, and 46% routinely prescribed antacids for life. The vast majority of pancreatic surgeons - 119 (89%) have encountered marginal ulcer after PD.
Conclusions: Prescribing antacid therapy after PD represents common practice among pancreatic surgeons worldwide. The duration of antacid treatment is variable; however, nearly half of surveyed pancreatic surgeons continued antacid treatment lifelong. The overwhelming majority of pancreatic surgeons have encountered marginal ulcer after PD.
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