The effect of jejunal nutrition on pancreatic exocrine function.
Pancreatic juice was continuously diverted from the Wirsungial duct by nasopancreatic drainage of the remnant of the gland after pylorus preserving partial pancreato-duodenectomy in 14 patients. On the 7th postoperative day with stabilized pancreatic secretion the juice was collected in 10 min fractions, while interdigestive secretory phases of the parenchyma were established by volume changes. At the beginning of a phase, 100 ml slightly hyperosmolar (400 mOsm/l) oligopeptide diet with 360 kJ (90) kCal) was given as a bolus injection to another 7 patients or 60 min infusion into the second jejunal loop by fine-needle catheter jejunostomy to another 7 patients. Pancreatic water, bicarbonate, protein, chymotrypsin, peak amylase levels, and integrated secretory responses were measured. It was observed that infusion of the diet did not disturb cycling interdigestive phases and did not increase peak and integrated outputs. Bolus administration interrupted interdigestive phases and stimulated pancreatic water, bicarbonate, protein, chymotrypsin and amylase outputs nonparallelly. On the basis of the data it was concluded that pancreatic secretion seems to be well preserved without duodenal regulatory mechanisms, and continuous jejunal infusion feeding seems to be useful in pancreatic disease and in other postoperative states when pancreas has to be put into rest.
Department of Surgery, Semmelweis University Medical School, Budapest, Hungary.
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Harsányi
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Bodoky
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Pap
D000714:Anastomosis, Surgical; D002908:Chronic Disease; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000502:physiology* / Q000601:surgery; D010189:Pancreatic Juice / Q000502:physiology*; D016577:Pancreaticoduodenectomy; D010195:Pancreatitis / Q000503:physiopathology* / Q000601:surgery; D013270:Stomach / Q000601:surgery