Ilecolonic interposed reconstruction after total gastrectomy (ICI) as substitute stomach seems clinically potent to reduce postgastrectomy syndrome. However, physiological features after ICI are poorly understood.
Aims. To study postprandial motility of interposed colon, PYY releasing and level of blood sugar (BS) after ICI.
Methods. In native control (NC; n=4) and in ICI dogs (n=4), motility was recorded by strain gauge transducers method. When the liquid meal was given directly into the proximal jejunum via a silastic tube in NC dogs, this model was regard as modified totally gastrectomized (TG) dogs. Postprandial plasma PYY and BS were measured at before and 15, 30, 60, 90, 120 minutes after giving liquid meal (10ml/kg, 1kcal/ml) in NC, TG and ICI dogs.
Results. In NC dogs, colonic bursts of contractions (CBOC) was evident both in fasted and fed state (1.3±0.1/hr). When ICI dogs were fed, decreasing in basal tone, so-called 'receptive relaxation', and a series of irregular intermittent weak contractions were noted in the interposed colon as in the native stomach. Time to appearance of CBOC after feeding was significantly longer in ICI dogs (167±19 min) than in NC dogs (20±3 min; p<0.001). Basal and peak plasma PYY were significantly higher in ICI dogs than in NC dogs (Table). Postprandial BS was significantly increased in TG dogs (Table).
Conclusions. Fed motility of the interposed colon mimicked native stomach. Postprandial PYY releasing, which may relate to 'ileocolonic brake' mechanism, was significantly higher, and postprandial fluctuation of BS was spare in ICI dogs. These may, in part, explain the reduction of postgastrectomy syndrome after ICI reconstruction.
Time after meal (min) 0 15 30 60 90 120
NC-PYY (fmol/ml) 89±5 104±23 124±3 110±38 90±5 111±20
ICI-PYY(fmol/ml) 191±15* 633±80* 694±36* 676±113* 526±74* 485±67*
NC-BS (mg/dl) 67±13 98±11 109±9 90±2 106±27 109±32
ICI-BS (mg/dl) 77±5 121±22 116±14 107±29 89±12 85±13
Mod. TG-BS (mg/dl) 87±3 138±3 190±7* 254±13* 242±59* 234±35*
* p<0.05 (ANOVA)