Skip to main content

Duodenal Interdigestive Migrating Motor Complex in Patients 5 Years or More after Pylorus-preserving Gastrectomy for Early Gastric Cancer

World Journal of Surgery volume 30, pages 1459–1467 (2006)Cite this article

Abstract

Background

We investigated the relationship between interdigestive migrating motor complex, phase III (IMMC-pIII) and postoperative quality of life (QOL) in pylorus-preserving gastrectomy (PPG) patients.

Materials and Methods

A total of 40 patients (26 men and 14 women; average age 59.4 years) 5 to 7.5 years after PPG for early gastric cancer (Billroth I) (average 6 years and 3 months) were divided into two groups according to the occurrence of IMMC-pIII from the duodenum, and their postoperative quality of life (QOL) was compared.

Results

As for appetite, “No change compared with before operation” was significantly more frequent in the IMMC-pIII positive group compared with the negative group (P = 0.0002). Food consumption per meal compared with normal; “80% or more” was significantly more frequent in the IMMC-pIII positive group than the negative group (P = 0.0002). Body weight loss during 5 years after surgery; “6 kg or more” was significantly more frequent in the IMMC-pIII negative group than the positive group (P = 0.0002). Early dumping symptoms did not occur in any patients of either group. Reflux esophagitis and nausea; no patients in the IMMC-pIII positive group experienced these symptoms, which was significantly different from the negative group (P = 0.0018). Abdominal pain occurred but was significantly less frequent in the IMMC-pIII positive group than in the negative group (P = 0.0023). Epigastric fullness occurred but was less frequent in the IMMC-pIII positive group compared with the negative group (P < 0.0001). Gastric stasis of the remnant stomach was significantly more frequent in the IMMC-pIII negative group than in the positive group (P < 0.0001). Gholelithiasis was significantly more frequent in the IMMC-pIII negative group than in the positive group (P = 0.0119).

Conclusions

These results showed more satisfactory QOL in the IMMC-PIII positive group than in the negative group.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Figure 1
Figure 2

References

  1. Maki T, Shiratori T, Hatafuku T, Sugawara K. Pylorus-preserving gastrectomy as an improved operation for gastric cancer. Surgery 1967;61:838–842

    PubMed  CAS  Google Scholar 

  2. Kodama M, Koyama K, Chida T, et al. Early postoperative evaluation of pylorus-preserving gastrectomy for gastric cancer. World J Surg 1995;19:456–461

    PubMed  CAS  Article  Google Scholar 

  3. Wu CW, Hsieh MC, Lo SS, et al. Quality of life of patients with gastric adenocarcinoma after curative gastrectomy. World J Surg 1997;21:777–782

    PubMed  CAS  Article  Google Scholar 

  4. Mori Y, Arita T, Shimoda K, et al. Jejunal interposition to prevent postgastrectomy syndromes. Br J Surg 2000;87:1576–1579

    Article  Google Scholar 

  5. Nakane Y, Akehira K, Inoue K, et al. Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer. Hepato-Gastroenterol 2000;47:590–595

    CAS  Google Scholar 

  6. Hida Y, Katoh H. new method for the jejunal pouch interposition to prevent postgastrectomy syndrome. Hepato-Gastroenterology 2000;47:1495–1497

    PubMed  CAS  Google Scholar 

  7. Tomita R, Fujisaki S, Tanjoh K. An operative technique on nearly total gastrectomy reconstructed by interposition of a jejunal J pouch with preservation of vagal nerve, lower esophageal sphincter and pyloric sphincter for early gastric cancer. World J Surg 2001;25:1524–1531

    PubMed  CAS  Google Scholar 

  8. Takahashi T, Yoshida M, Kubota T, et al. Morphologic analysis of gastroesophageal reflux diseases in patients after distal gastrectomy. World J Surg 2005;29:50–57

    PubMed  Article  Google Scholar 

  9. Tomita R, Takizawa H, Tanjoh K. Physiological effects of cisapride on gastric emptying after pylorus-preserving gastrectomy for early gastric cancer. World J Surg 1998;22:35–41

    PubMed  CAS  Article  Google Scholar 

  10. Nakabayashi T, Mochiki E, Garcia M, et al. Pyloric motility after pylorus-preserving gastrectomy with or without pyloric branch of the vagus nerve. World J Surg 2002;26:577–583

    PubMed  Article  Google Scholar 

  11. Nakabayashi T, Mochiki E, Kamiyama Y, et al. Erythromycin induces pyloric relaxation accompanied by a contraction of the gastric body after pylorus-preserving gastrectomy. Surgery 2003;133:647–655

    PubMed  Article  Google Scholar 

  12. Tomita R, Fujisaki S, Tanjoh K. Pathophysiological studies on the relationship between postgastrectomy syndrome and gastric emptying function at 5 years after pylorus-preserving distal gastrectomy for early gastric cancer. World J Surg 2003;27:725–733

    PubMed  Article  Google Scholar 

  13. Yamaguchi T, Ichikawa D, Kurioka H, et al. Postoperative clinical evaluation following pylorus-preserving gastrectomy. Hepato-Gastroenterology 2004;51:883–886

    PubMed  Google Scholar 

  14. Bueno L, Fioramonti. Food and gastrointestinal motility. In Kumar D, Wingate D, editors, Gastrointestinal motility. 2nd ed. Edinburgh, Churchill Livingstone, 1993;130–143

  15. Penning C, Gielkens HA, Hemelaar M, et al. Reproducibility of antroduodenalmotility during prolonged ambulatory recording. Neurogastroenterol Motil 2001;13:133–141

    PubMed  CAS  Article  Google Scholar 

  16. Luiking YC, Akkermans LM, Peeters TL, et al. Effects of motilin on human interdigestive gastrointestinal and gallbladder motility, and involvement of 5HT3 receptors. Neurogastroenterol Motil 2002;14:151–159

    PubMed  CAS  Article  Google Scholar 

  17. Tomita R, Fujisaki S, Tanjoh K, et al. Relationship between jejunal interdigestive migrating motor complex and quality of life after total gastrectomy with Roux-en Y reconstruction for early gastric cancer. World J Surg 2003;27:159–163

    PubMed  Google Scholar 

  18. Tomita R, Fujisaki S, Tanjoh K, et al. Studies on gastrointestinal hormone and jejunal interdigestive migrating motor complex in patients with or without early dumping syndrome after total gastrectomy with Roux-en-Y reconstruction for early gastric cancer. Am J Surg 2003;185:354–359

    PubMed  CAS  Article  Google Scholar 

  19. Fukuhara H, Imamaura H, Kodera K. The role of surgery in the current treatment of gastric cancer. Gastric Cancer 2002;5:13–16

    Article  Google Scholar 

  20. Ikeda Y, Saku M, Kawanaka H, et al. Prophylactic lymph node dissection for early gastric cancer invading submucosa. Hepato-Gastroenterology 2004;51:887–890

    PubMed  Google Scholar 

  21. Shibata C, Sasaki I, Naito H, et al. Gastrointestinal motor activity after pylorus-preserving gastrectomy with or without vagotomy in dogs. J Am Coll Surg 1995;181:545–551

    PubMed  CAS  Google Scholar 

  22. Qvist N, Oster-Jorgensen E, et al. Gastric antrectomy with selective gastric vagotomy does not influence gallbladder motility during interdigestive and postprandial periods. Dig Dis Sci 1996;41:835–839

    PubMed  CAS  Article  Google Scholar 

  23. Nakane Y, Michiura T, Inoue K, et al. Length of the antral segment in pylorus-preserving gastrectomy. Br J Surg 2002;89:220–224

    PubMed  CAS  Google Scholar 

  24. Nabae T, Takahashi S, Konomi H. Effect of prepyloric gastric resection and anastomosis on sphincter of Oddi cyclic motility in conscious dogs. J Gastroenterol 2001;36:530–537

    PubMed  CAS  Article  Google Scholar 

  25. Itoh Z. Changes in plasma motilin concentration and gastrointestinal contractile activity in the conscious dog. Ann J Dig Dis 1978;23:926–935

    Google Scholar 

  26. Peeters TL, Janssens J, Vantrappen GR. Somatostatin and interdigestive migrating motor complex in man. Regul Pept 1983;5:209–214

    PubMed  CAS  Article  Google Scholar 

  27. Luiking YC, Kloppers NJ, Roelofs JM, et al. Effects of intraduodenal bile on interdigestive gastrointestinal and gallbladder motility in healthy subjects. Digestion. 2001;63:195–202

    PubMed  CAS  Article  Google Scholar 

  28. Simern M, Bjornsson ES, Abrahamsson H. High interdigestive and postprandial motility levels in patients with the irritable bowel syndrome. Neurogastroenterol Motil 2005;17:51–57

    Article  Google Scholar 

  29. Tomita R, Kurosu Y, Munakata K, et al. Migrating motor complex and gastrointestinal hormones in humans. Nihon Univ J Med 1993;35:287–293

    Google Scholar 

  30. Itoh H, Nagano T, Takeyama M. Effects of mosapride citrate on human plasma levels of motilin, gastrin, somatostatin, and secretin. Biol Pharm Bull 2001;24:1072–1075

    PubMed  CAS  Article  Google Scholar 

  31. Makimoto N, Sakurai-Yamashita Y, et al. In vitro assessment of acceleration of motor activity associated with acetylcholine release via 5-hydroxytryptamine 4receptor in dog intestine. Jpn J Pharmacol 2002;90:28–35

    PubMed  CAS  Article  Google Scholar 

  32. Calvert EL, Whorwell PJ, Houghton LA. Inter-digestive and post-prandial antro-pyloro-duodenal motor activity in humans: effect of 5-hydroxytryptamine 1 receptor agonist. Aliment Pharmacol Ther 2004;19:805–815

    PubMed  CAS  Article  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Surgery, Nippon Dental University School of Dentistry at Tokyo, 2-3-16 Fujimi, Chiyoda-ku, Tokyo, 102-8158, Japan

    Ryouichi Tomita MD, PhD, Tugumichi Koshinaga MD & Taro Ikeda MD

  2. First Department of Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-0032, Japan

    Ryouichi Tomita MD, PhD, Shigeru Fujisaki MD & Katsuhisa Tanjoh MD

Authors
  1. Ryouichi Tomita MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tugumichi Koshinaga MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Taro Ikeda MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shigeru Fujisaki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Katsuhisa Tanjoh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryouichi Tomita MD, PhD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Tomita, R., Koshinaga, T., Ikeda, T. et al. Duodenal Interdigestive Migrating Motor Complex in Patients 5 Years or More after Pylorus-preserving Gastrectomy for Early Gastric Cancer. World J. Surg. 30, 1459–1467 (2006). https://doi.org/10.1007/s00268-005-0676-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-005-0676-7

Keywords

  • Early Gastric Cancer
  • Reflux Esophagitis
  • Negative Group
  • Vagal Nerve
  • Remnant Stomach