IPAD trial finds no gastric-emptying benefit from side-to-side gastrojejunostomy after pancreatoduodenectomy

Delayed gastric emptying is a frequent complication after pancreatoduodenectomy, and retrospective studies have suggested that gastrojejunostomy configuration may influence its incidence. The prospective, open-label IPAD trial, reported in Annals of Surgery, randomized 158 adults undergoing pancreatoduodenectomy for benign or malignant disease at two high-volume French pancreatic centers. Patients were assigned intraoperatively to side-to-side or end-to-side gastrojejunostomy, with 79 per group, and followed for 90 days. The primary endpoint was delayed gastric emptying.

Delayed gastric emptying occurred in 38.0% of the side-to-side group and 30.4% of the end-to-side group (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 did not differ, and GastroIntestinal Quality of Life Index scores were 87.9 versus 86.6, respectively (P=0.68).

The findings do not support choosing side-to-side reconstruction specifically to reduce delayed gastric emptying. However, the confidence interval does not establish equivalence between techniques. Interpretation should also account for the open-label design, enrollment at only two high-volume centers, and baseline imbalances in sex distribution, hypertension and chronic obstructive pulmonary disease.