Delayed gastric emptying (DGE) following pancreatic surgery

This leaflet is written to provide information and advice for those with delayed gastric emptying following pancreatic surgery.

What is delayed gastric emptying?

When you eat, food travels from your mouth into your stomach, and is then emptied into your intestine. DGE is a condition where the stomach takes longer than usual to empty its contents into your intestine than it usually does. This means the food stays in your stomach longer, potentially causing feelings of fullness, bloating, nausea and vomiting. These symptoms may be ongoing, but are often intermittent; meaning you may have no symptoms for a few days. However, as your stomach fills up, you start to feel increasingly uncomfortable and then you may vomit large amounts, leading to a relief of symptoms until your stomach fills again.

Why has this happened to me after my surgery?

The exact cause of DGE is unknown but it is thought to be a reaction to your intestine having been handled during the operation and from having had surgery on your stomach and part of your small intestine. Unfortunately, we do not yet know how best to reduce the risk of this happening nor can we predict who is most at risk of developing this. However, DGE is one of the most frequent complications following pancreatic surgery and the surgeons, ward nurses and dietitians are very familiar with supporting people experiencing this issue.

How will I manage whilst I have DGE?

If your stomach is not emptying effectively, it could lead to you experiencing nausea, vomiting and potentially some of your stomach contents coming up and then going the wrong way into your airway (aspiration). Your surgeon may advise to keep (or reinsert) a nasogastric (NG) tube; this goes in your nose to your stomach. This is a drainage tube that prevents a build-up of contents in your stomach.

Some people with mild DGE can drink enough nourishing fluids to give their bodies the nutrients they need. However, most people will need to receive their nutrition via an alternative route that bypasses their stomach. To do this, you will need a second tube called a nasojejunal (NJ) feeding tube to be passed through your nose, beyond your stomach and into your intestine.

This thin NJ tube will likely be inserted in the endoscopy department. A feeding pump can then be used to deliver liquid feeds through this tube. If for any reason it is not possible to place an NJ tube, then you will need to have a feed directly into your bloodstream through a drip into a vein. This is called parenteral nutrition (PN).

You will likely be prescribed medications which encourage your stomach to empty; known as prokinetic medications. Examples are metoclopramide, domperidone and erythromycin. The best timings and route of taking these and other medications will be considered by the surgeons and ward pharmacist.

Can I eat and drink?

Your surgeons will discuss with you what you can eat and drink. They will review your symptoms and how much is coming out of your NG drain to help assess how well your stomach is emptying. If you are struggling with nausea and/or vomiting and/or a lot is coming out of your NG tube, then you will be advised to limit what you have by mouth to only sips of fluids.

When you have less nausea and the amount coming out of your NG drain is consistently lower in volume, you will be advised to gradually build up what you are having by mouth. At first, you are likely to better manage liquids and softer foods such as milky drinks, yogurts, mashed potato, custard, ice cream and rice pudding. It is important not to have too much of anything at one time. Try to spread out what you have over the day, to give your stomach more time to empty. You should avoid fizzy drinks. You may be advised to avoid high fat and high fibre foods as these can slow down stomach emptying. It is also sensible to avoid drinking large amounts at mealtimes. As the amount you can eat without feeling unwell increases, the dietitian will advise a reduction in the amount of liquid feed you get through your NJ tube, so you continue to get the nourishment you need.

How long will DGE last and is there anything I can do to help?

Unfortunately, we cannot predict how long DGE will last. However, it usually gets better gradually over a period of weeks, and in some cases, a few months. Only a minority of people continue to have prolonged symptoms of DGE beyond this.

It is recommended that you keep as active as possible, as this will encourage your stomach to start working. Try to avoid spending long periods of time in bed and sit out in your chair as much as possible. Set yourself a daily activity goal. For example, walking a certain number of ‘laps’ up and down the ward corridor or doing some simple chair exercises. Please do ask to speak to a physiotherapist or discuss with your nurse if you have any queries or concerns about this.

It has been suggested that the chewing action created by chewing gum may help stimulate your stomach and intestine to start working better following other types of surgery. This has not been fully examined in people who have had pancreatic surgery and the evidence is limited. However, it may be worth trying chewing gum as a way of encouraging your stomach to empty.

Experiencing DGE can feel like a setback following your surgery and can be a very frustrating and challenging time. We encourage you to talk about how you are feeling with your family, close friends and staff at the hospital. Please do let the surgical team know if you would find it helpful to speak to someone more about how you are feeling. Other professionals such as the chaplaincy, specialist nurses or the psychiatric team can come and chat with you further if this is helpful.

Will I be able to go home before my DGE resolves?

If your DGE is taking a while to resolve and you are otherwise medically ready to go home, the team may discuss with you about going home with the NJ feeding tube. The nutrition nurse team will then help to train you and/or your carer or family member on how to use the feeding pump and care for the NJ tube. The dietitians will work with you to make a plan for when you have the feed at home so it fits in with your life. You will be provided with all the nutritional feed and equipment needed including a much smaller drip stand than the one you have in hospital.

You will be given contact numbers including a 24-hour helpline to call if you need any advice with the pump/feeding tube when you are at home. It is rare for patients to be able to go home with the NG drainage tube as well, but if this is suggested, the nurses on the ward will teach you how to look after this.

You will not be discharged home until you and the team are happy that you will be able to safely manage with the tube(s) at home. If you do go home with the NJ feeding tube, a dietitian will be in regular contact with you to support you in this and the transition back to oral diet. Patients who go home with DGE may need regular blood tests at their GP practice, which will be arranged by the medical team.

Contacts/Further information

If you have any questions or would like to discuss in more detail what you have read here in more detail, please do ask to talk to one of the surgeons, specialist nurses or dietitians.