Plasma Cholecystokinin and Pancreatic Polypeptide Response after Radical Pancreatoduodenectomy with Billroth I and Billroth II Type of Reconstruction

Abstract

This study was conducted to elucidate plasma cholecystokinin (CCK) and pancreatic polypeptide (PP) response after pancreatoduodenectomy and to compare response of CCK and PP in patients who had pancreatoduodenectomy with Billroth I and Billroth II type of reconstruction. Basal levels of plasma CCK were significantly lower in patients who had pancreatoduodenectomy (9.6 +/- 0.8 pmol/L) than in the control (preoperative patients: 14.6 +/- 2.0 pmol/L) probably because of the removal of the entire duodenum due to pancreatoduodenectomy, since vagotomy, which is concomitantly brought about by pancreatoduodenectomy, does not appear to interfere with release of CCK. Significant amounts of CCK (integrated CCK: 497 +/- 111 pmol-120 min/L), although less amounts than in the preoperative patients (integrated CCK: 901 +/- 167 pmol-120 min/L), were still released in response to oral fatty meal after pancreatoduodenectomy. Plasma CCK response to oral fatty meal was significantly greater in patients who had pancreatoduodenectomy with Billroth I type of reconstruction (integrated CCK: 705 +/- 153 pmol-120 min/L) than in patients who had pancreatoduodenectomy with Billroth II type of reconstruction (248 +/- 63 pmol-120 min/L). Simultaneous measurement of plasma levels of PP revealed complete abolishment of PP response by pancreatoduodenectomy. Since PP secretion can be produced by vagal stimulation, it is most likely that the decreased PP secretion is due to vagotomy rather than removal of the duodenum and pancreas. Significant amounts of CCK released after pancreatoduodenectomy, in which the main sources of release of CCK are removed, may suggest the compensatory mechanism of the remnant upper small intestine. This study also suggests the necessity of re-evaluating Billroth I type of anastomosis as a physiologic reconstruction procedure for the remnant alimentary tract after pancreatoduodenectomy.

Enhancing effect of partial gastrectomy on pancreatic carcinogenesis

“…1987;Malfertheiner et al, 1987: Rieu et al. 1990 CCK response is in line with other reports both in man and the rat (Hopman et al, 1984;Inoue et al. 1987: Malfertheiner et al.…”

“…Although partial gastrectomy does not increase fasting levels of CCK in man or the rat, the CCK response to ingested fat is markedly greater in both species (Hopman et al. 1984;Inoue et al. 1987;Malfertheiner et al.…”

Duct-to-Mucosa Pancreaticojejunostomy Compared to ‘Dunk’ after Whipple’s Resection

“…Even the elderly can be operated on with comparable outcome [15][16]. A Bill roth-1-type reconstruction as used in the present series, with the biliary anastomosis in the natural position 4-5 cm distal to the duodenojejunal anastomosis, was first described by Watson [17], The excellent functional and physiological results of this method of restoration of gas trointestinal continuity after pancreaticoduodenectomy have been confirmed by others [18][19][20].…”

Pancreatogenic Diabetes: Special Considerations for Management

“…To explore the cause of this dichotomy in hepatic and peripheral insulin sensitivity, the role of pancreatic polypeptide (PP) was considered, as PP deficiency had also been documented in CP [31], pancreatic resection [32] and cystic fibrosis [33]. Bastidas et al [34] were unable to show any effect of acute administration of bovine PP on glucose metabolism and insulin action in an animal model of CP; however, Sun et al [26] found that the prolonged administration of PP for hours or days resulted in a reversal of the hepatic resistance to insulin in dogs with CP.…”