Ann Clin Nutr Metab.  2025 Apr;17(1):9-17. 10.15747/ACNM.25.0007.

Pathogenesis, risk factors, and management of postoperative delayed gastric emptying after distal gastrectomy: a narrative review

• Oh CA

• KMID: 2566718
• DOI: http://doi.org/10.15747/ACNM.25.0007

Abstract

Purpose
This narrative review elucidates the complex pathogenesis, key risk factors, and effective management strategies for postoperative delayed gastric emptying (DGE) following distal gastrectomy with D2 lymphadenectomy, a definitive procedure for middle and lower gastric cancer. It also explores opportunities for improved prevention and innovative treatment options.
Current concept
DGE significantly disrupts gastric motility and presents with symptoms such as early satiety, postprandial fullness, nausea, vomiting, and gastric atony. Although rarely fatal, DGE hampers oral intake, prolongs hospital stays, and diminishes quality of life. Current evidence indicates that DGE is a multifactorial disorder resulting from an interplay of vagal nerve disruption, damage to smooth muscle and interstitial cells of Cajal, imbalances in gastrointestinal hormones, and postoperative gut microbiome dysbiosis. Patient-specific factors, including advanced age, poor nutritional status, diabetes, and preoperative pyloric obstruction, along with surgical factors (most notably Billroth II reconstruction), further increase the risk of DGE. Management involves dietary modifications, prokinetic agents (such as metoclopramide and selective 5-HT4 agonists like prucalopride), and gastric decompression.
Conclusion
DGE is a challenging complication following gastrectomy that demands a deeper understanding of its underlying mechanisms to improve patient outcomes. Emerging therapies, including microbiota modulation and advanced pharmacological agents, offer promising new treatment avenues.

Keyword

Gastrectomy; Gastrointestinal microbiome; Gastroparesis; Risk factors; Stomach neoplasms