Changes of the Gastric Motility after Pylorus Preserving Pancreaticoduodenectomy

Park, Jong Kwon; Seo, Jung Jin; Jun, Ho Jin; Chung, Min; Park, Dong Guk; Kim, Jung Taik; Lim, Chang Young; Park, Seok Gun

Abstract

BACKGROUND: To evaluate delayed gastric emptying after a pylorus-preserving pancreaticoduodenectomy, we studied gastric motility in 11 normal volunteers and 11 patients who had undergone a pylorus-preserving pancreaticoduodenectomy. Additionally, the 24 hour esophageal Ph recordings were examined to evaluate gastroesophageal reflux after a pylorus-preserving pancreaticoduodenectomy.
METHODS
Gastric motility was evaluated by using the gastric-emptying time and electrogastrograms. The gastric-emptying time was measured using a solid meal containing 99mTc-tin colloid. The half gastric-emptying time (GET1/2) was defined as the half time (T1/2) of the fall of gastric isotopic activity from the peak. Electrogastrogram (EGG) signals were detected from the surface electrodes on the skin overlying the gastric antrum. The 24-hour esophageal Ph was monitored by using a nasoesophageal probe placed in the distal esophagus 5 cm above the lower esophageal sphincter.
RESULTS
In our study, the normal volunteers showed a 99+/-35 minute half gastric-emptying time. The patients were divided into two groups by a time of 2 months after the operation, early and late postoperative groups. Delayed gastric emptying after a pylorus-preserving pancreaticoduodenectomy in the early postoperative period (272+/-176 minutes) was normalized in the late period (106+/-37 minutes), p=0.020. Abnormal early EGG patterns also normalized in the late postoperative period. There was no significant difference of total Ph<4-time % between patients in the early (0.1+/-0.1%) and the late postoperative periods (0.4+/-0.4%), p=0.064.
CONCLUSIONS
It is supposed that anatomical and functional preservation of the stomach and the proximal part of the duodenum after a pylorus-preserving pancreaticoduodenectomy enabled gastric motor activity to be normal in the late postoperative period.