Abstracts
2000 Digestive Disease Week

# 2305 Impact of Preservation of the Gastroduodenal Transit on Gastrointestinal Hormones After Surgery for Chronic Pancreatitis.
Christian Bloechle, Tammo V. Schrenck, Andreas De Weerth, Timm Strotmann, Jakob R. Izbicki, Hamburg, Germany

Background: In chronic pancreatitis (CP) classical resection, i.e. partial pancreatoduodenectomy (PD) according to Whipple, includes resection of the distal stomach and duodenum. Duodenum-preserving resection of the head of the pancreas (DPRHP) and local pancreatic head excision with longitudinal pancreaticojejunostomy (LPHE-LPJ) preserve gastrointestinal (GI) transit. Aim of this study was to analyse the impact of preservation of the GI transit on the secretion of GI function regulating hormones: neurotensin (NT), pancreatic polypeptide (PP), and peptide YY (PYY). Patients and Methods: In a prospective randomized trial 28 patients suffering CP underwent either PD (n=8), DPRHP (n=10) or LPHE-LPJ (n=10). Prior to and 6 months after surgery, plasma concentrations of NT, PP, and PYY were determined before and after standardized test meal stimulation (550 ml, 1062 kcal: 15% protein, 27% fat, 58% carbohydrates). (t: -30, -15, 0, +15, +30, to +120 min). Seven healthy persons served as controls. Results: Prior to surgery NTincreased from 27.8 to 44.2 pmol/l (p<0.), PP from 23.to 97.6 pmol/l (p<0,01) and PYY from 19.to 55.pmol/l (p<0,05). Six months after surgery, in the PD group the rise of NT (20.to 39.pmol/l) was delayed (p<0.). After DPRHP NT-concentration rose from 32.4 to 60.0pmol/l, and after LPHE-LPJ from 37.1 to 68.1 pmol/l. Postop. NT secretion was increased after DPRHP and after LPHE-LPJ compared to preop. NT secretion (p<0.01). In the PD group PP concentration was 5.pmol/l without increase. After DPRHP PP increased from 23.to 57.pmol/l and after LPHELPJ from 20.to 52.0 pmol/l (p<0.). Postop. PP secretion was significantly lower compared to preop. secretion after both, DPRHP and LPHE-LPJ. PYY concentrations were not significantly different between groups. Conclusions: Preservation of GI transit by DPRHP and LPHE-LPJ results in an increased NT secretion, while NT secretion is decreased after PD. PP secretion is maintained after DPRHP and LPHE-LPJ, but not after PD. PYY secretion is not influenced by GI transit preserving surgery for CP.