STUDY FOR THE CAUSE OF DELAYED GASTRIC EMPTYING AFTER PYLORUS-PRESERVING PANCREATODUODENECTOMY

1997 Fiscal Year Final Research Report Summary

• Project/Area Number: 08671482
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Single-year Grants
• Section: 一般
• Research Field: Digestive surgery
• Research Institution: KEIO UNIVERSITY
• Principal Investigator: TAKAHASHI Shin KEIO UNIVERSITY SCHOOL OF MEDICINE,ASSISTANT PROFESSOR, 医学部, 専任講師 (50129508)
• Co-Investigator(Kenkyū-buntansha): TAMAGAWA Eiji KEIO UNIVERSITY SCHOOL OF MEDICINE,INSTRUCTOR, 医学部, 助手 (00255473)
• Project Period (FY): 1996 – 1997
• Keywords: PYLORUS-PRESERVING PANCREATODUODENECTOMY / DELAYED GASTRIC EMPTYING / INTERMITTENT MIGRATING COMPLEX / BLOOD ACETAMINOPHEN CONCENTRATION / BLOOD MOTILIN CONCENTRATION

Research Abstract

We performed the experiments described below in mongrel dogs in order to explain the cause of delayd gastric emptying after pylorus-preserving pancreatoduodenectomy (PPPD). Strain gauge force transducers (SGT) were attached to the body of the stomach, the antrum, and the lifted jejunum, in three groups of animals : a control group, a PPPD-acute group, and a PPD-chronic group, and intestinal motility was observed. Gastric emptying was simultaneously monitored by blood acetaminophen aconcentrations, and blood motilin concentrations were also determined.
In the control group, intermittent migrating complexes (IMC) having a mean duration of 15 min 42 sec occurred regularly with a mean cycle of 108 min in the interdigestive state in the body and antrum. In the PPPD-acute dogs, emptying was delayd, and retention of gastric contents and the patency of the pyloric ring were confirmed. In the PPPD chronic dogs, a strong contraction group resembling IMC emerged on POD 14 in the body and antrum, b ut the cycle and the duration were both irregular. When this contraction group and IMC were compared, the initiation cycle and the duration in the contraction group on POD 14 were significantly shorter compared to the IMC.On POD 28, the duration was significantly shorter, but there was no difference in the initiation cycle.
The pyloric ring of the dogs was patent in the early period after PPPD,but the fact that IMD did not occur in the body or the antrum and that a strong contraction group of short duration occurred irregularly appeared to be responsible for the retention of gastric contents. In the chronic period, a strong contraction group resembling IMC was observed, and the gastric emptying recovered. However, the blood motilin concentrations when this strong contraction group emerged were lower than when IMC occurred in the control group, and the decrease in motilin production associated with removal of the duodenum also appeared to be one of the causes that led to the retention of gastric contents after PPPD.