Abstract
We hypothesize that the presence of a few secretin-releasing cells sited in the upper jejunum may provoke a postprandial secretin response to meal loading in patients who have undergone the Whipple procedure. This procedure involves gastrectomy and total duodenectomy and requires gastrointestinal tract reconstruction by one of three methods: (i) choledocho-pancreatico-gastro alignment (PD-1), (ii) pancreatico-choledocho-gastro alignment (PD-2) (both these methods excluding the upper jejunum from the route of food passage), or (iii) gastro-pancreatico-choledocho alignment (PD-3), in which food passes through the upper jejunum. Fasting and postprandial plasma secretin and gastrin response were measured in 47 Whipple-treated patients, 16 given a PD-1, 15 given a PD-2, and 16 given a PD-3, and in 15 healthy controls. Plasma secretin response and integrated secretin release were higher, but not significantly, in the PD-3 group, and lower in all three Whipple-treated groups than in the control (P<0.05). Plasma gastrin concentration showed no significant increase in any of the three treated groups and was significantly lower than in the controls (P<0.05). The integrated gastrin release also did not differ among the treated groups and was lower than in the controls (P<0.05). Twenty-four-h monitoring showed that the gastric pH was neutral or alkaline in all three treated groups. The failure to prove our hypothesis may be due to the presence of too few secretin-releasing cells in the upper jejunum to respond to the meal loading and/or to the intragastric pH not being sufficiently acidic to stimulate those secretin-releasing cells present in the upper jejunum.
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References
Traverso LW, Longmire WP (1978) Preservation of the pylorus in pancreatoduodenectomy. Surg Gynecol Obstet 146:956–962
Braash JW, Rossi RL, Watkins E Jr, et al. (1986) Pylorus and gastric preservation pancreatic resection: Experience with 87 patients. Ann Surg 204:411–417
Kamal M, Itani F, Coleman RE, et al. (1986) Pylorus-preserving pancreatoduodenectomy: A clinical and physiologic appraisal. Ann Surg 204:655–664
Takada T (1993) Pylorus-preserving pancreatoduodenectomy: Its technique and indications. Hepatogastroenterology 40:422–425
Miyazaki I (1989) Historical aspects of a pancreaticoduodenectomy (in Japanese). In: Miyazaki I, Takada T (eds) Pancreatoduodenectomy. Igakutosho Publishing, Tokyo, pp 1–9
Japan Pancreatic Society (1993) General rules for the study of pancreatic cancer 4th edn (in Japanese). Kanehara Publishing, Tokyo
Takada T, Yasuda H, Shikata J, et al. (1989) Postprandial plasma gastrin and secretin concentrations after a pancreatoduodenectomy: A comparison between a pylorus-preserving pancreatoduodenectomy and the Whipple Procedure. Ann Surg 210:47–51
Bloom SR, Polak JM (1978) Gut hormone overview. In: Bloom SR (ed) Gut hormones. Churchill Livingston, Edinburgh, pp 3–18
Chey WY, Lee YH, Hedricks JG, et al. (1978) Plasma secretin concentrations in fasting and postprandial state in man. Dig Dis 23:981–988
Watanabe S, Shiratori K, Takeuchi T (1981) Radiommunoassay of secretin using an ethanol plasma extraction method: Significant increase of plasma secretin concentrations after a meal in man (in Japanese). Nippon Shokakibyou Gakkai Zasshi (Jpn J Gastroenterol Surg) 78:1920–1927
Shiratori K, Watanabe S, Takeuchi T (1983) Radioimmunoassay of secretin with special reference to an evaluation of its sensitivity (in Japanese). Nippon Shokakibyo Gakkai Zasshi (Jpn J Gastroenterol Surg) 80:1475–1479
Yamashita Y, Noutomi M, Isomoto H, et al. (1981) Procedures of a gastrointestinal reconstruction after pancreaticoduodenectomy and exocrine pancreatic functioning of the remnant pancreas (in Japanese). Nippon Shokakigeka Gakkai Zasshi (Jpn J Gastroenterol Surg) 18:594–1601
Sudo T, Ishiyama K, Kawamura M, et al. (1984) Changes in plasma gastrin and secretin levels after pancreaticoduodenectomy. Surg Gynecol Obstet 58:133–136
Inoue K, Tobe T, Suzuki T, et al. (1987) Plasma cholecystokinin and pancreatic polypeptide response after radical pancreatoduodenectomy with a Billroth 1 or Billroth 2 type of reconstruction. Ann Surg 206:148–154
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Takada, T., Yasuda, H., Watanabe, S. et al. Postprandial plasma secretin response in Whipple-treated patients. J Hep Bil Pancr Surg 3, 54–59 (1996). https://doi.org/10.1007/BF01212781
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DOI: https://doi.org/10.1007/BF01212781