2005 Abstracts: Amelioration of Postgastrectomy Syndrome After Pylorus-Preserving Gastrectomy
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Amelioration of Postgastrectomy Syndrome After Pylorus-Preserving Gastrectomy
Koji Nakada, Naruo KAWASAKI, Tomoko NAKAYOSHI, Nobuyoshi HANYU, Hideyuki KASHIWAGI, Katsuhiko YANAGA, Jikei University School of Medicine, Department of Surgery, Tokyo, japan, Japan
Postgastrectomy syndrome is commonly seen in gastrectomized patients. Altered gastric emptying by the operation may have a role in the pathogenesis of postgastrectomy syndrome. In Japan, pylorus-preserving distal gastrectomy (PPG) is often performed for early gastric cancer located in the mid-stomach, and is thought to attenuate postgastrectomy syndrome by slowing gastric emptying.
AIM: To compare gastric emptying both solid and liquid meal between pylorus-preserving distal gastrectomy (PPG) and conventional distal gastrectomy (DPG) using the 13C-breath test. METHODS: Gastric emptying of solid and liquid meal were studied in controls (42 for solids and 57 for liquids), DPG patients (13) and PPG patients (11). For solids, a fried egg (100mg of 13C-octanoic acid was mixed with egg yolk), a bun, 4 g of butter, and 160 ml of clear soup (230 kcal) were given. For liquids, Racol (200kcal/200ml; Otsuka Pharm. Co. Ltd, Tokyo, Japan) mixed with 100 mg of 13C-acetate was given. Breath samples were collected before and 15, 30, 45, 60, 75, 90, 105, 120, 150, 180, 210, and 240 minutes after meal for solids, and before and as well as 5, 10, 15, 20, 30, 40, 50, 60, 75, 90, 105, 120, 135, 150, 165, 180, 210, and 240 minutes after meal for liquids. 13CO2 content was measured by infrared spectrophotometry. Gastric emptying was evaluated by Tmax in 13C-%dose/hr curve. Gastric emptying of both solid and liquid meal was compared among the groups. RESULTS: For controls, DPG patients and PPG patients, gastric emptying of the solids was 105±5.2, 54.2±6.5* and 150±6.7 minutes, respectively and of the liquids was 43.2±1.5, 12.3±1.1* and 34.5±5.2 minutes, respectively. (* p<0.05 vs. controls and vs. PPG patients). CONCLUSIONS: Rapid gastric emptying of both solid and liquid meal was found in DPG patients. This may, in part, explain pathogenesis of postgastrectomy syndrome. PPG procedure seems beneficial to reduce postgastrectomy syndrome by ameliorating rapid gastric emptying after distal gastrectomy.
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