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ANALYSIS OF FAT ABSORPTIVE FUNCTION AND GALLBLADDER MOTILITY AFTER SUBTOTAL GASTRECTOMY BY A 13C-BREATH TEST
Masahiko Morifuji*1,2, Naru Kondo2, Kenichiro Uemura2, Naoya Nakagawa2
1Tsukuba Central Hospital, Ushiku City, Japan; 2Hiroshima Univercity, Hiroshima City, Japan
Background: Digestive and absorptive disturbances with resultant post-gastrectomy weight loss remain the problem in selecting reconstructive method for the alimentary tract. We used the 13C-breath test to detect fat absorptive function and gallbladder motility after subtotal gastrectomy employing Billroth I (B-I) and Roux-Y (R-Y) reconstructions.
Methods: A 13C-labeled mixed triglyceride breath test (200 mg 13C-MTG, 20 g fat, and breath samples over 7 hours) was performed in 32 patients (22 males and 9 females) after subtotal gastrectomy and in 17 healthy volunteers (H-V, 10 males and 7 females). Written informed consent was obtained from all patients and volunteers who agreed to participate in this study and approval was granted by ethical committee of Hiroshima University and Hiroshima Memorial Hospital. Fat absorptive function was determined by percentage cumulative dose at 7h (%CD-7h), and gallbladder function was calculated by the ejection fraction (EF) using ultrasonography.
Results: The gender distribution, meaen age, TNM staging, level of lymph node dissection in the two surgical groups did not differ significantly. The %CD-7h of the R-Y group (8.5±3.1%) was less than that of H-V group (15.2±7.8%, P=0.032) and that of B-I group (11.2±6.8%). There was no significant difference between the %CD-7h of the H-V and B-I group. Body weight loss ratio in the B-I group (90.5±5.7%) and R-Y group (89.5 ± 7.7%) did not differ significantly. In the mean EF of gallbladder, B-I group (48.5 ± 15.6%) showed similar course to that of R-Y group (46.3 ± 14.4%). EF of two groups was less than that of H-V (67.8 ± 8.0%, P＜0.001). The follow-up period did not significantly affect to EF of gallbladder after subtotal gastrectomy.
Conclusion: Fat absorptive function after B-I reconstruction was superior to that after R-Y reconstruction, probably because the B-I reconstruction was the procedure that permitted food passage through the duodenum. Difference of gallbladder motility was not detected in this two groups.
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