Inhibitory effect of jejunal high caloric nutrient load on human biliopancreatic secretion. The role of atropine, naloxone and composition of nutrient solutions

Sogni, P.; Vidon, N; Chaussade, Stanislas; Huchet, B

doi:10.1016/0261-5614(93)90141-p

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…It goes against the reported increased risk of long‐term exocrine insufficiency associated with PG after PD, the most frequently cited reason being that reflux of gastric juices would cause inactivation of the pancreatic enzymes and early insufficiency of the remnant pancreas unlike PJ . Although, some authors advanced that the anatomical change of PJ may provide a negative feedback following a high‐caloric jejunal load resulting in reduced exocrine secretion . We did not assess the pancreatic remnant volume, which could be also a confounding factor in exocrine function outcomes .…”

Section: Discussionmentioning

confidence: 97%

Pancreatico‐jejunostomy decreases post‐operative pancreatic fistula incidence and severity after central pancreatectomy

Borel

Ouaïssi²,

Merdrignac

et al. 2017

ANZ Journal of Surgery

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Backgrounds: Central pancreatectomy (CP) is an alternative to pancreaticoduodenectomy and distal pancreatectomy in benign tumours of pancreatic isthmus management. It is known for a high post-operative pancreatic fistula (POPF) rate. The purpose of this study was to compare POPF incidence between pancreatico-jejunostomy (PJ) and pancreaticogastrostomy (PG). Methods: Fifty-eight patients (mean age 53.9 AE 1.9 years) who underwent a CP in four French University Hospitals from 1988 to 2011 were analysed. The distal pancreatic remnant was either anastomosed to the stomach (44.8%, n = 25) or to a Roux-en-Y jejunal loop (55.2%, n = 35) with routine external drainage allowing a systematic search for POPF. POPF severity was classified according to the International Study Group on Pancreatic Fistula (ISGPF) and Clavien-Dindo classifications. Results: The groups were similar on sex ratio, mean age, ASA score, pancreas texture, operative time and operative blood loss. Mean follow-up was 36.2 AE 3.9 months. POPF were significantly more frequent after PG (76.9 versus 37.5%, P = 0.003). PG was associated with significantly higher grade of POPF both when graded with ISGPF classification (P = 0.012) and Clavien-Dindo classification (P = 0.044). There was no significant difference in postoperative bleeding (0.918) and delayed gastric emptying (0.877) between the two groups. Hospital length of stay was increased after PG (23.6 AE 3.5 days versus 16.5 AE 1.9 days, P = 0.071). There was no significant difference in incidence of long-term exocrine (3.8 versus 19.2%, P = 0.134) and endocrine (7.7 versus 9.4%, P = 0.575) pancreatic insufficiencies. Conclusion: PG was associated with a significantly higher POPF incidence and severity in CP. We recommend performing PJ especially in older patients to improve CP outcomes.

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Section: Discussionmentioning

confidence: 97%

Pancreatico‐jejunostomy decreases post‐operative pancreatic fistula incidence and severity after central pancreatectomy

Borel

Ouaïssi²,

Merdrignac

et al. 2017

ANZ Journal of Surgery

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“…Involution of pancreatic tissue may also occur without anastomotic stenosis following disruption of the pancreatic neurohormonal stimulating mechanisms resulting from pancreaticoduodenectomy. In addition, negative feedback following a high-caloric jejunal load may result in reduced exocrine secretion 22 .…”

Section: Discussionmentioning

confidence: 99%

Functional and morphological changes in the pancreatic remnant following pancreaticoduodenectomy with pancreaticogastric anastomosis

Lemaire

O’Toole

Sauvanet

et al. 2000

Journal of British Surgery

165

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“…Therefore, the buffering capacity of the food may protect the pancreatic enzymes from denaturation at the time when they are required for digestion, and the PG may not be detrimental in the exocrine pancreatic function. When a PJ is performed, there is no concern about the acid pH, but the changing anatomy may provide a negative feedback following a high-caloric jejunal load which results in reduced exocrine secretion [30] . Regardless of the type of reconstruction, PD survivors should be carefully followed up for evidence of pancreatic endocrine and exocrine insufficiency [31] .…”

Section: Clinical Considerations Of Pancreatic Exocrine Insufficiencymentioning

confidence: 99%

Considerations on pancreatic exocrine function after pancreaticoduodenectomy

Morera-Ocón¹,

Sabater-Ortí²,

Muñoz-Forner³

et al. 2014

WJGO

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The pancreaticoduodenectomy (PD) procedure may lead to pancreatic exocrine and endocrine insufficiency. There are several types of reconstruction for this kind of operation. Pancreaticogastrostomy (PG) was introduced to reduce the rate of postoperative pancreatic fistula. Although some randomized control trials have shown no differences regarding pancreatic leakage between PG and pancreaticojejunostomy (PJ), recently some reports reveal benefits from the PG over the PJ. Some surgeons concern about the performing of the PG and inactivation of pancreatic enzymes being in contact with the gastric juice, and the detrimental results over the exocrine pancreatic function. The pancreatic exocrine function can be measured with direct and indirect tests. Direct tests have the highest sensitivity and specificity for detection of exocrine insufficiency but require tube placement. Among the tubeless indirect tests, the van de Kamer stool fat analysis remains the standard to diagnose fat malabsorption. The patient compliance and time consuming makes it not so suitable for its clinical use. Fecal immunoreactive elastase test is employed for screening of exocrine insufficiency, is not cumbersome, and has been used to study pancreatic function after resection. We analyze the FE1 levels in our patients after the PD with two types of reconstruction, PG and PJ, and we discuss some considerations about the pancreaticointestinal drainage method after pancreaticoduodenectomy. Core tip: Many patients present pancreatic exocrine insufficiency after pancreatic resection. Exocrine insufficiency leads to steatorrhoea, flatulence, abdominal pain, weight loss and malnutrition. Extent of resection will determine the severity of insufficiency, but also changes in anatomy may be determining factors. Pancreatogastrostomy is deemed detrimental over the pancreatic function because of the hypothetical inactivation of pancreatic enzymes due to the acid juice of the stomach. In this review we discuss the physiological aspects of the changes in exocrine pancreatic function focusing on the pancreatoenterostomy after a pancreaticoduodenectomy.Morera-Ocon FJ, Sabater-Orti L, Muñoz-Forner E, Pérez-Griera J, Ortega-Serrano J. Considerations on pancreatic exocrine function after pancreaticoduodenectomy. World J Gastrointest Oncol 2014; 6(9): 325-329 Available from:

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Inhibitory effect of jejunal high caloric nutrient load on human biliopancreatic secretion. The role of atropine, naloxone and composition of nutrient solutions

Cited by 5 publications

References 16 publications

Pancreatico‐jejunostomy decreases post‐operative pancreatic fistula incidence and severity after central pancreatectomy

Pancreatico‐jejunostomy decreases post‐operative pancreatic fistula incidence and severity after central pancreatectomy

Functional and morphological changes in the pancreatic remnant following pancreaticoduodenectomy with pancreaticogastric anastomosis

Considerations on pancreatic exocrine function after pancreaticoduodenectomy

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