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PubMed1975

[Gastric irrigation and secretion in the ligatured or fistuled pylorus rat upon influence of intra-duodenal olive oil (author's transl)].

Pylorus ligature hides the inhibitory effects of endogenous cholecystokinine-pancreozyme (CCK-PZ) on gastric mucosal secretion and irrigation, whereas the juice collected through transduodenal pyloric fistula makes this phenomenon obvious. It appears that the pyloric fistula encourages inhibition of gastrinic secretion, so that the CCK-PZ can achieve its effects.

Animals↗
PubMed1976

Effect of subdiaphragmatic vagotomy on production of gastric ulcers in pylorus-ligated albino rats.

A reduction in volume and free and total acidity of gastric content was noted along with reduction in ulcer index, with a shift of the site of ulceration from fundus to the glandular part of the stomach, following vagotomy in pylorus-ligated rats. Low volume and acidity explains the absence of ulcers in the fundus, but the increased involvement of glandular part in ulceration is possibly due to weakening of the mucosal barrier following vagotomy.

Animals↗
PubMed1990

Vagal afferent innervation of the pylorus and the upper small intestine studied in the rat with the horseradish peroxidase technique.

The neuronal tracer horseradish peroxidase was injected into different segments of the gastrointestinal in the rat, in order to study the vagal afferent innervation. In the nodose ganglia the extent of labeling was greater in the experiments on the gastric antrum and pylorus than in the experiments on the first part of the small intestine. Vagal afferents are scarce in the upper duodenum and originate mainly from the left nodose ganglion.

Afferent Pathways↗
PubMed1995

Effects of nonsteroidal antiinflammatory drugs on ulcerogenesis and gastric secretion in pylorus-ligated rat.

The effects of nonsteroidal antiinflammatory drugs on ulcerogenesis and gastric secretion were evaluated in a pylorus-ligated rat model. Oral administration of salicylate (50 mg/kg), aspirin (50 mg/kg), and indomethacin (3.5 mg/kg) significantly increased ulcerogenesis over the basal value by six- to sevenfold, but ibuprofen's (10 mg/kg) fourfold increase was not significant. Aspirin in conjunction with histamine (0.5 mg/kg subcutaneously) significantly increased ulcerogenesis by 2.7-fold compared to histamine alone. Basal acid secretion was increased significantly by 156% after indomethacin, but not by other nonsteroidal antiinflammatory drugs. In contrast, all nonsteroidal antiinflammatory drugs, except indomethacin, significantly decreased histamine-stimulated acid secretion. Non-steroidal antiinflammatory drugs had no effect on pepsinogen secretion. Ranitidine pretreatment (25 mg/kg intraperitoneally) significantly decreased basal acid and pepsinogen secretion in all treatment groups by > 85% and > 40%, respectively, and ulcerations induced by salicylate, aspirin, and indomethacin were also inhibited by 90%, 60%, and 60%, respectively. The observed inhibition of prostaglandin E2 generation by nonsteroidal antiinflammatory drugs under basal secretory conditions appeared to correlate with the extent of ulcerogenesis. Our data support the concept that acid, in addition to inhibition of prostaglandin E2 synthesis, plays an important role in the pathogenesis of nonsteroidal antiinflammatory drug-induced gastropathy.

Animals↗
PubMed1994

Volume measurements of gastric antrum by 3-D ultrasonography and flow measurements through the pylorus by duplex technique.

We present a method for estimating volumes of abdominal organs using 3-D ultrasonography. In vitro validation experiments demonstrated excellent agreement between estimated and true volumes. In vivo estimations after ingestion of 500 ml meat soup showed greater antral filling and poorer emptying of the gallbladder in patients with functional dyspepsia (FD) than in healthy controls. Abnormal antral filling was associated with dyspeptic symptoms. The relationship between motility and transpyloric movements of luminal contents after ingestion of 500 ml meat soup was studied in healthy subjects by duplex technique. Accurate timing of antegrade and retrograde flow were recorded using bidirectional velocity curves. Mid-cycle and end-cycle reflux were often observed; end-cycle reflux was more frequent in conjunction with coordinated than with uncoordinated antroduodenal contractions. The peristaltic closure of the pylorus was normally preceded by a short gush of duodenogastric reflux.

Dyspepsia↗
PubMed2002

Comparison of the functional outcome after pylorus-preserving pancreatoduodenectomy: pancreatogastrostomy and pancreatojejunostomy.

To determine if there is any difference in pancreatic function after pylorus-preserving pancreatoduodenectomy(PPPD) according to the type of pancreatoenterostomy [pancreatojejunostomy (P-J) or pancreatogastrostomy (P-G)], we evaluated the long-term functional status of 34 patients who underwent PPPD and survived for more than 1 year without clinical evidence of recurrence. Altogether 20 patients underwent P-J and 14 P-G. To compare the two groups, we analyzed the (1) general nutritional status; (2) quality of life using three scoring systems; (3) gastrointestinal symptoms; and (4) pancreatic exocrine function by the stool elastase I test and endocrine function by oral glucose tolerance test (GTT). After PPPD, body weight decreased in both groups, with no difference between the two groups. No statistical differences were found in triceps skinfold thickness or serum protein/albumin. Regarding the quality of life and postoperative gastrointestinal symptoms, there were no differences between the two groups except steatorrhea. There were 4 mild and 15 severe cases of pancreatic exocrine insufficiency among those who underwent P-J, whereas all of the patients who underwent P-G showed severe pancreatic insufficiency. On GTT, excluding preoperative diabetes patients, 43.8% (7/16) of the P-J group had abnormal results after surgery, whereas 75.0% (9/12) of the PG group had an abnormal postoperative GTT (p = 0.11). Severe exocrine and endocrine pancreatic insufficiency developed after PPPD in both the P-J and P-G groups, but there was more functional deterioration in the P-G group than in the P-J group. General nutritional status and quality of life were not affected by the pancreatoenterostomy method in either group.

Adult↗
PubMed2002

Pylorus-preserving gastrectomy: effect on resistance through the sphincter of Oddi compared to conventional distal gastrectomy in dogs.

Bile stasis is an important etiologic factor in the high incidence of postgastrectomy gallstone disease (PGGD). Our previous study showed that duodenal, but not prepyloric, transection disturbed the motility of the sphincter of Oddi (SO) in anesthetized dogs. We had developed pylorus-preserving gastrectomy (PPG), in which the anal margin of the resected stomach is the prepyloric portion, not the duodenum. The present study evaluated the usefulness of PPG for reducing bile stasis, which may induce PGGD. We examined the resistance of bile flow through the SO using dogs that had undergone either PPG (n = 5) or conventional distal gastrectomy ( B-I) (n = 5). Four weeks after gastrectomy we anesthetized the animals and compared the basal and volume load-induced pressure in the common bile duct (CBD) between groups with or without administration of cholecystokinin-8 (CCK8). Flow resistance of the SO was evaluated by measuring flow volume through the SO following a graded pressure load to the CBD. The basal pressure and the threshold pressure to open the SO were significantly lower in PPG dogs than in B-I dogs independent of CCK8 administration. There were no significant differences between groups in regard to volume load-induced pressure elevation or the resistance of the SO. These results indicate that PPG may be more useful for reducing the incidence of PGGD than conventional distal gastrectomy, possibly through attenuating resistance to bile flow.

Animals↗
PubMed2003

Pylorus-preserving pancreaticoduodenectomy in the treatment of chronic pancreatitis.

The pylorus-preserving pancreaticoduodenectomy (PPPD) is an alternative to the standard Whipple resection in the treatment of chronic pancreatitis. The operation is safe and can be performed with a low mortality rate. The most common early complication is delayed gastric emptying, which occurs in 25% to 30% of patients, and generally results in longer hospital stays than the standard Whipple procedure. Follow-up studies show that both operations are equally effective in relieving pain in approximately 75% of selected patients. In the long term, the PPPD successfully preserves physiologic gastric emptying, but at the cost of a higher marginal ulceration rate. The purported nutritional advantages of the PPPD over the classic Whipple resection have not been clearly established. At present, the PPPD is the procedure of choice for patients with chronic pancreatitis requiring panceraticoduodenectomy. Based on available information, this recommendation appears to arise form the fact that the PPPD is less radical than the regular Whipple procedure, and some surgeons find it technically easier. Our experience fails to show a distinct superiority of the PPPD over the Whipple operation.

Chronic Disease↗
PubMed2004

Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial.

The aim of the present study was to compare in a prospective, multicenter trial the results early and late after pylorus-preserving gastrectomy (PPG) versus conventional distal gastrectomy (CDG) with Billroth I anastomosis for early gastric cancer. Eighty-one patients with early gastric cancer were randomized and then underwent either PPG or CDG. Duration of operation, intraoperative blood loss, days until removal of the nasogastric tube, days until start of oral intake, and decrease in body weight were studied as parameters for outcomes early after the surgery. Late results were studied in patients followed for longer than 3 years. Change in body weight, status of oral intake, symptoms suggesting early dumping syndrome, and overall satisfaction were addressed in the questionnaire. The presence of gallstones was examined with ultrasonography. There were no differences in early results between PPG and CDG. The incidence of early dumping syndrome was lower in PPG (8%) than in CDG (33%). Other late results including the incidence of gallstones were not different between the 2 groups. These results indicate that PPG is as safe as CDG and has an advantage in terms of early dumping syndrome.

Female↗
PubMed2006

Duodenal interdigestive migrating motor complex in patients 5 years or more after pylorus-preserving gastrectomy for early gastric cancer.

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.

Duodenum↗
PubMed2006

Assessment of the preserved function of the remnant stomach in pylorus-preserving gastrectomy by gastric emptying scintigraphy.

BACKGROUND: This study evaluated the preserved function of the remnant stomach by gastric emptying scintigraphy in patients who underwent pylorus-preserving gastrectomy (PPG), and it investigated whether this examination method is a useful tool for evaluation. MATERIALS AND METHODS: The residual stomach function was evaluated by gastric emptying scintigraphy in 45 patients with early gastric cancer who had undergone PPG. Function was classified as rapid, intermediate, and delayed emptying types according to gastric emptying curves. Then, the relationships were examined between the gastric emptying types and postprandial symptoms, food intake status, body weight changes, and endoscopic findings. RESULTS: Seventy-three percent of the PPG patients were classified as belonging to the intermediate emptying type, and the remainder to the delayed emptying type. The frequencies of complaints such as epigastric fullness, nausea, and vomiting were high in the delayed emptying-type patients. The intermediate emptying-type patients consumed larger amounts of food and gained more weight than the delayed emptying-type patients. It was difficult to estimate gastric emptying function from endoscopic findings. CONCLUSIONS: Gastric function was evaluated by gastric emptying scintigraphy in PPG patients. This method might be useful not only for evaluating the motor function of the remnant stomach, but also for predicting postoperative status.

Adult↗
PubMed2000

Manometric evidence of improved early gastric stasis by erythromycin after pylorus-preserving pancreatoduodenectomy.

Gastric stasis is a frequent complication of pylorus-preserving pancreatoduodenectomy (PPPD). We demonstrated that it might be attributable to delayed recovery of phase III activity of the gastric migrating motor complex due to low concentrations of plasma motilin caused by resection of the duodenum. Leucine 13-motilin is effective for treating gastric stasis, but it is not yet available for clinical use. Whether erythromycin would improve early gastric stasis after PPPD was tested clinically and by manometry. A manometric tube assembly and a gastrostomy tube were inserted in the stomach of 10 patients at PPPD for pressure recording from the gastric antrum and jejunum and for gastric juice drainage, respectively. After baseline recording, erythromycin 5 mg/kg was given intravenously on day 14 and saline as a placebo on day 17 every 4 hours four times a day. The daily volume of gastric juice output and the gastric motility index were measured. The mean period until the return of gastric phase III was 31 +/- 1 days. Erythromycin significantly increased the gastric motility index from 7.9 +/- 1.3 mmHg to 15.7 +/- 1.8 mmHg (p = 0.0005), whereas saline did not (7.2 +/- 1.6 mmHg to 6.5 +/- 1.2 mmHg; p = 0.21). Erythromycin significantly decreased the gastric juice output from 1,080 +/- 190 ml to 738 +/- 199 ml (p < 0.0001), but the saline injections did not (1,064 +/- 174 ml to 1,115 +/- 189 ml; p = 0.35). Erythromycin, a universally available motilin agonist, is a safe, effective, potent drug for the treatment of early gastric stasis after PPPD.

Aged↗
PubMed2000

Pylorus-preserving total pancreatectomy for pancreatic cancer.

Standard total pancreatectomy (TP) combined with gastric resection often results in uncontrollable diabetes and malnutrition. Pylorus-preserving total pancreatectomy (PPTP) and standard TP for pancreatic cancer were compared in terms of operative outcomes, nutritional recovery, and long-term survival. Twenty-four patients with pancreatic ductal adenocarcinoma (n = 14) or intraductal papillary mucinous carcinoma (N = 10) underwent PPTP (n = 10) or standard TP (n = 14). There were no significant differences in age, gender, or tumor type or stage between the PPTP and standard TP groups. Early (within 30 days of surgery) morbidity and mortality rates were 20% and 0% for PPTP and 29% and 7% for standard TP, respectively. Delayed gastric emptying occurred in 2 patients in each group. The incidence of late complications, including uncontrollable diabetes, diarrhea, and malnutrition, tended to be lower after PPTP (30%) than after standard TP (69%). Serum albumin and body weight at 6 months after surgery were significantly higher in the PPTP than in the standard TP group. Regardless of the tumor type, long-term survival did not differ significantly between patients receiving PPTP and those with standard TP. PPTP for pancreatic cancer improves nutritional recovery, without compromising long-term survival, compared with standard TP.

Adenocarcinoma↗
PubMed2000

Gastric acidity following pancreaticogastrostomy with pylorus-preserving pancreaticoduodenectomy.

Pancreaticogastrostomy (PG) has been reintroduced and employed occasionally as a useful alternative to pancreaticojejunostomy (PJ) after Whipple resection or pylorus-preserving pancreaticoduodenectomy (PPPD). Although the physiologic alteration in the stomach is important for the correlation between gastric and pancreatic functions, the actual intragastric pH profile after PG is still unclear. This study was conducted to investigate the physiologic changes in gastric pH and serum gastrin and secretin levels before and after PPPD reconstructed with PG (PPPD-PG) in humans. Twenty-four hour continuous intragastric pH and serum gastrin and secretin levels in the fasting state were examined in 25 patients who had undergone PPPD-PG. No peptic ulcer was detected after the operation. After PG, serum gastrin and secretin levels were unchanged. Twenty-four hour gastric pH monitoring revealed two distinct patterns during the nocturnal period before the operation: patients with acid-type secretion (n = 11) exhibited a persistent acid pH, whereas those with alkaline-type secretion (n = 14) had cyclic variations between an acid and an alkaline pH value. After PG, in both acid- and alkaline-type patients, median pH and percentages of time that the gastric pH was less than 4 (% pH < 4) and more than 6 (% pH > 6) did not change, and circadian pH patterns also remained unchanged. These results suggest that PPPD-PG has little influence on gastric acidity, and the neurohumoral relation between the stomach, duodenum, and pancreas is preserved after PG. Therefore, physiologically, PG can be recommended as a reconstructive procedure after PPPD.

Adult↗
PubMed2003

Diagnosis of angiodysplasia on the caudal aspect of the pylorus: need for side-viewing endoscopy.

Recurrent gastrointestinal bleeding in patients with upper gastrointestinal angiodysplasia is common after treatment. This probably is related to the difficulty identifying all the lesions because they frequently are multiple and can be located in areas not easily visualized with forward-viewing endoscopy. We report two cases of patients with gastrointestinal bleeding in whom angiodysplasia as found at surgical enteroscopy on the caudal aspect of the pylorus that could not be identified with forward-viewing endoscopy. The lesions were ablated at the time of surgery or subsequently after location with side-viewing endoscopy, and no further bleeding occurred.

Angiodysplasia↗
PubMed2004

Acinar cell carcinoma of the pancreas eroding the pylorus and duodenal bulb.

A 74-year-old woman presented at the National Defense Medical College Hospital in April 2001 with a chief complaint of upper abdominal pain. She had been diagnosed as having adenocarcinoma on the basis of results of examination of a biopsy specimen taken from an ulcer of the duodenal bulb at a local hospital. On admission, she showed no jaundice, but a hard mass, about 10 cm in diameter, was palpated in the right upper quadrant. Laboratory data showed high levels of serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9. Abdominal computed tomography (CT) and angiography demonstrated a giant enhanced mass in a pattern of eccentric gradation extending to the pylorus, duodenal bulb, and pancreatic head. She underwent pancreatoduodenectomy with combined resection of the transverse colon. The histologic diagnosis was acinar cell carcinoma (ACC), originating in the pancreatic head and extending to the stomach, duodenum, and transverse colon, without any lymph node involvement. In most reported cases of ACC, the preoperative diagnosis was a pancreatic mass or endocrine tumor of the pancreas. The correct diagnosis in those cases was made by postoperative or postmortem pathological examination. If criteria for detecting the slight differences between ACC and endocrine tumors on some images were to be established, the diagnostic skill for ACC would improve dramatically.

Aged↗
PubMed2006

Gastrointestinal function and quality of life after pylorus-preserving pancreatoduodenectomy.

The pylorus-preserving pancreatoduodenectomy (PPPD) has taken the place of the conventional Whipple pancreatoduodenectomy as the standard procedure for various periampullary disease. With recent advances in surgical techniques and improvements in perioperative management, the number of long-term survivors after PPPD is increasing. As a result, surgeons should pay more attention to the patients' postoperative gastrointestinal function, nutrition, and quality of life (QOL). Gastric stasis, which is a frequent complication during the early postoperative period after PPPD, prolongs the hospital stay and impairs the QOL in the intermediate term. Several possible pathogeneses for this gastric stasis have been postulated; however, the precise mechanism remains unclear. The gastric emptying function gradually recovers to the preoperative level by 6 months after PPPD. Pancreatic functions are likely to be maintained for at least 1 year after PPPD; however, in some cases, they tend to gradually deteriorate over time after the operation, depending on the type of pancreatic reconstruction or the preoperative condition of the pancreas. It is important to note that preoperative and postoperative pancreatic exocrine function strongly influence the postoperative outcome regarding such factors as pancreatic fistula, body weight maintenance, nutrition, and the QOL. The QOL, as assessed by questionnaire, normally returns to the preoperative level within 6 months after PPPD, and this correlates with the changes in gastrointestinal function and nutritional status. It still remains an unresolved question, however, whether the Billroth-I PPPD really leads to better long-term nutritional status, but worse early gastric emptying function, than the Billroth-II type of reconstruction.

Gastric Emptying↗
PubMed1999

Early and late complications of pylorus-preserving pancreatoduodenectomy in Japan 1998.

Early (within 1 month after operation) and late (more than 1 month after surgery) complications after pylorus-preserving pancreatoduodenectomy (PpPD) were analyzed in 1066 Japanese patients collected from 74 authentic institutions in Japan. As early postoperative complications after PpPD, delayed gastric emptying was evident in 46% of patients, pancreatoenterostomy leakage in 16%, intra-abdominal infection in 14%, cholangitis in 8.9%, hepaticojejunostomy leakage in 4.7%, intra-abdominal hemorrhage in 3. 5%, upper gastrointestinal hemorrhage in 3.2%, and duodenojejunostomy leakage in 2.0%. Delayed gastric emptying resolved 1-24 months after PpPD (mean, 3.1 months). The direct operative mortality (death within 1 month after the operation) was 2. 4%. Univariate and multivariate analysis of pancreatoenterostomy leakage showed that male sex (P = 0.0151) and soft consistency of the pancreas (P < 0.0001) were independent significant factors. Univariate analysis of delayed gastric emptying showed that establishment of gastrostomy (P < 0.0001), length of the preserved duodenum (P = 0.0406), gastric juice output (P = 0.0001), length of gastric tube placement (P < 0.0001), and administration of cisapride (P = 0.0059) were significant variants. As late complications, stomal ulcer was evident in 3.6% of patients, cholangitis in 6.7%, and liver abscess in 1.2%. Glucose intolerance appeared in 61 patients, resolved in 15, showed no change in 170, was absent in 695, and was ameliorated in 17. As a result, the dosage of hypoglycemic agents or insulin showed no change in 187 patients, decreased in 16, and increased in 52. Diabetes appeared 0-42 months after PpPD (mean, 102 months). When present, diabetes deteriorated 0-36 months postoperatively (mean, 6.3 months). Univariate analysis of the appearance or deterioration of diabetes showed that diabetes occurred more frequently in the following patients; those with Billroth I reconstruction compared with those with Billroth II (P = 0.0041), those with pancreatogastrostomy vs those with pancreatojejunostomy (P = 0.0229), those with pancreatogastrostomy vs those with end-to-side pancreatojejunostomy (P = 0.0165), and those with total tube drainage vs those with pancreatico-whole thickness anastomosis (P = 0.0392); a high American Society of Anesthesiologist (ASA) score (P = 0.0211) and pancreatoenterostomy leakage (P = 0.0361) were also significant factors. Postoperative body weight loss (>3 kg) was evident in 62% of patients. Body weight loss reached a maximum 4.2 +/- 5.8 months after PpPD (mean, 6.0 kg) and returned to the preoperative level 4.8 months thereafter. These results suggest that PpPD has been performed safely in Japan, the operative mortality being 2.4%. However, delayed gastric emptying was evident in 46% of the patients and pancreatoenterostomy leakage in 16%. Impairment of glucose tolerance occurred in about 10% of patients more than 1 month after PpPD. Therefore, during the early postoperative period, patients should be closely monitored for pancreatoenterostomy leakage and delayed gastric emptying and in the late postoperative period, glucose tolerance should be carefully followed-up.

Adolescent↗