Reviewer ’s report  
 
Title: Efficacy of gastric decompression after pancreatic surgery: a systematic review and meta -
analysis  
 
Version: 0 Date: 29 Feb 2020  
 
Reviewe r: Pierluigi Di Sebastiano  
 
Reviewer's report:  
 
The aim of this systematic review was to evaluate the necessity of routine gastric decompression 
(RGD) following pancreatic surgery.  The authors searched, following PRISMA criteria, the 
eligible studies comparing routine gastric decompression (RGD) with no gastric decompression 
(NGD) after pancreatic resection published  before Nov 3th 2019.   
 
The primary outcomes of this meta -analysis was the incidence of overall complications and 
major complications after pancreatic resections. Secondary outcomes included delayed gastric 
emptying, POPF, and postoperative mortality. Secondary gastric decompression and the length 
of hospital.  
 
No differe nces were found between the two group analyzed (decompressed or not) about overall 
complications. Significant differences were found in CR -DGE (clinical relevant delayed gastric 
emptying) and in hospital staying.   
 
The most important limitation of this met a-analysis is that all studies included had a retrospective 
design, which carries definitely for selection bias. The authors concluded the review stating that 
routine gastric decompression after pancreaticoduodenectomy did not have an effect on 
postoperati ve course.  This is in substantial agreement with the ERAS society guidelines, which 
however have reported only moderate evidence. According to the Kunstmann et all study 
(published in 2013 on the Journal of American College of Surgeons), I think that a "s elective" 
instead of a routine gastric decompression  seems an appropriate treatment strategy.  The lack of 
randomized trials makes it impossible to draw strenght conclusions.  
 
Hereby, I encourage the authors to propose a randomized study in their country (referring to their 
high volume center in pancreatic surgery) to confirm what is now only suggested.  
 
While adding little to the current state, the review is well structured and metodologically correct.   
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported b y the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specif y what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publi cation of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you curr ently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any  other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
'I declare that I have no competing interests'  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named re port 
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I underst and that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Efficacy of gastric decompression after pancreatic surgery: a systematic review and meta -
analysis  
 
Version: 0 Date: 29 Feb 2020  
 
Reviewe r: Pierluigi Di Sebastiano  
 
Reviewer's report:  
 
The aim of this systematic review was to evaluate the necessity of routine gastric decompression 
(RGD) following pancreatic surgery.  The authors searched, following PRISMA criteria, the 
eligible studies comparing routine gastric decompression (RGD) with no gastric decompression 
(NGD) after pancreatic resection published  before Nov 3th 2019.   
 
The primary outcomes of this meta -analysis was the incidence of overall complications and 
major complications after pancreatic resections. Secondary outcomes included delayed gastric 
emptying, POPF, and postoperative mortality. Secondary gastric decompression and the length 
of hospital.  
 
No differe nces were found between the two group analyzed (decompressed or not) about overall 
complications. Significant differences were found in CR -DGE (clinical relevant delayed gastric 
emptying) and in hospital staying.   
 
The most important limitation of this met a-analysis is that all studies included had a retrospective 
design, which carries definitely for selection bias. The authors concluded the review stating that 
routine gastric decompression after pancreaticoduodenectomy did not have an effect on 
postoperati ve course.  This is in substantial agreement with the ERAS society guidelines, which 
however have reported only moderate evidence. According to the Kunstmann et all study 
(published in 2013 on the Journal of American College of Surgeons), I think that a "s elective" 
instead of a routine gastric decompression  seems an appropriate treatment strategy.  The lack of 
randomized trials makes it impossible to draw strenght conclusions.  
 
Hereby, I encourage the authors to propose a randomized study in their country (referring to their 
high volume center in pancreatic surgery) to confirm what is now only suggested.  
 
While adding little to the current state, the review is well structured and metodologically correct.   
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported b y the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specif y what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publi cation of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you curr ently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any  other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
'I declare that I have no competing interests'  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named re port 
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I underst and that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Efficacy of gastric decompression after pancreatic surgery: a systematic review and meta -
analysis  
 
Version: 0 Date: 29 Feb 2020  
 
Reviewe r: Pierluigi Di Sebastiano  
 
Reviewer's report:  
 
The aim of this systematic review was to evaluate the necessity of routine gastric decompression 
(RGD) following pancreatic surgery.  The authors searched, following PRISMA criteria, the 
eligible studies comparing routine gastric decompression (RGD) with no gastric decompression 
(NGD) after pancreatic resection published  before Nov 3th 2019.   
 
The primary outcomes of this meta -analysis was the incidence of overall complications and 
major complications after pancreatic resections. Secondary outcomes included delayed gastric 
emptying, POPF, and postoperative mortality. Secondary gastric decompression and the length 
of hospital.  
 
No differe nces were found between the two group analyzed (decompressed or not) about overall 
complications. Significant differences were found in CR -DGE (clinical relevant delayed gastric 
emptying) and in hospital staying.   
 
The most important limitation of this met a-analysis is that all studies included had a retrospective 
design, which carries definitely for selection bias. The authors concluded the review stating that 
routine gastric decompression after pancreaticoduodenectomy did not have an effect on 
postoperati ve course.  This is in substantial agreement with the ERAS society guidelines, which 
however have reported only moderate evidence. According to the Kunstmann et all study 
(published in 2013 on the Journal of American College of Surgeons), I think that a "s elective" 
instead of a routine gastric decompression  seems an appropriate treatment strategy.  The lack of 
randomized trials makes it impossible to draw strenght conclusions.  
 
Hereby, I encourage the authors to propose a randomized study in their country (referring to their 
high volume center in pancreatic surgery) to confirm what is now only suggested.  
 
While adding little to the current state, the review is well structured and metodologically correct.   
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported b y the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specif y what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publi cation of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you curr ently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any  other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
'I declare that I have no competing interests'  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named re port 
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I underst and that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant