TY - JOUR
T1 - Impaired emptying of the retained distal stomach causes delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy
AU - Shan, Yan Shen
AU - Hsieh, Yu Hsiang
AU - Yao, Wei Jen
AU - Tsai, Mei Ling
AU - Lin, Pin Wen
PY - 2007/8
Y1 - 2007/8
N2 - Objective: Delayed gastric emptying (DGE) is the major morbidity after pylorus-preserving pancreaticoduodenectomy (PPPD). Gastroscintigraphy was used to characterize food distribution in the proximal and distal stomach during emptying. Patients and Methods: Between October 2000 and June 2003, 20 healthy volunteers and 23 PPPD patients underwent single-phase gastric emptying scintigraphy 14 days after surgery. Scintigraphic studies of the stomach were divided into proximal and distal regions, and the ratio of proximal to distal radiation counts (P/DR) was plotted. Momentary monitor-displayed images were compared to evaluate meal distribution during emptying. Results: There were 21 eligible patients, 12 without symptoms of DGE (sDGE-) and 9 with symptoms of DGE (sDGE+). In healthy volunteers the mean P/DR value was maintained at a level of ≥ 2.5, and momentary images showed dilated proximal and constricted distal stomach throughout meal emptying. In both the solid and liquid phase tests, the average P/DR value for sDGE- patients was slightly lower than that for healthy volunteers, and momentary images showed early emptying of the solid meal. The mean P/DR value for sDGE+ patients was abnormally low and remained constant throughout the assessment. Momentary images showed significant dilatation of the distal stomach, with constant full size. The odds ratio for the change in P/DR per minute decreased after surgery, especially in sDGE+ patients, indicating a loss of contractility of the distal stomach. At the 6-month follow-up, the P/DR values exhibited a normal decreasing trend but were lower for sDGE+ patients than for healthy volunteers. Conclusions: The P/DR curve provides new insight into normal and pathological gastric function. After surgery, temporary loss of contractility of the distal stomach causes symptoms of DGE.
AB - Objective: Delayed gastric emptying (DGE) is the major morbidity after pylorus-preserving pancreaticoduodenectomy (PPPD). Gastroscintigraphy was used to characterize food distribution in the proximal and distal stomach during emptying. Patients and Methods: Between October 2000 and June 2003, 20 healthy volunteers and 23 PPPD patients underwent single-phase gastric emptying scintigraphy 14 days after surgery. Scintigraphic studies of the stomach were divided into proximal and distal regions, and the ratio of proximal to distal radiation counts (P/DR) was plotted. Momentary monitor-displayed images were compared to evaluate meal distribution during emptying. Results: There were 21 eligible patients, 12 without symptoms of DGE (sDGE-) and 9 with symptoms of DGE (sDGE+). In healthy volunteers the mean P/DR value was maintained at a level of ≥ 2.5, and momentary images showed dilated proximal and constricted distal stomach throughout meal emptying. In both the solid and liquid phase tests, the average P/DR value for sDGE- patients was slightly lower than that for healthy volunteers, and momentary images showed early emptying of the solid meal. The mean P/DR value for sDGE+ patients was abnormally low and remained constant throughout the assessment. Momentary images showed significant dilatation of the distal stomach, with constant full size. The odds ratio for the change in P/DR per minute decreased after surgery, especially in sDGE+ patients, indicating a loss of contractility of the distal stomach. At the 6-month follow-up, the P/DR values exhibited a normal decreasing trend but were lower for sDGE+ patients than for healthy volunteers. Conclusions: The P/DR curve provides new insight into normal and pathological gastric function. After surgery, temporary loss of contractility of the distal stomach causes symptoms of DGE.
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U2 - 10.1007/s00268-007-9100-9
DO - 10.1007/s00268-007-9100-9
M3 - Article
C2 - 17566824
AN - SCOPUS:34447327841
SN - 0364-2313
VL - 31
SP - 1606
EP - 1615
JO - World Journal of Surgery
JF - World Journal of Surgery
IS - 8
ER -