title: Comparative effects of enteric-coated pancreatin microsphere therapy after conventional and pylorus-preserving pancreatoduodenectomy.
abstract: BACKGROUND
  A comparative study was performed between patients with exocrine pancreatic insufficiency after conventional pancreatoduodenectomy (Whipple's procedure) and pylorus-preserving pancreatoduodenectomy (PPPD). In these patients the pharmacodynamics of 2-mm enteric-coated pancreatin microspheres (ECPMs) and their gastric transit time in relation to that of a solid meal were investigated. The efficacy of ECPM preparations may differ after Whipple's procedure compared with PPPD, because the latter procedure does not include gastrectomy.
  
  
  METHODS
  Gastric transit was assessed by double-isotope scintigraphy. A pancake meal was labelled with 99mTc. ECPMs were cold-labelled with 170Er and neutron activated shortly before ingestion to enable imaging with a gamma camera. Intraluminal pancreatic enzyme activity was assessed during a 6-h period with two indirect tests: the cholesteryl [14C]octanoate breath test and the N-benzoyl-L-tyrosyl-p-aminobenzoic acid-p-aminosalicylic acid (NBT-PABA-PAS) test.
  
  
  RESULTS
  In patients who had Whipple's procedure, the gastric transit time of ECPMs and of the pancake meal was not significantly different. The outcome of the indirect pancreatic function tests during enzyme supplementation was comparable, and not significantly different, from that in healthy volunteers. In patients who had PPPD, however, the gastric transit time of microspheres was greatly delayed compared with that of the pancake meal (P < 0.05). Improvement in the outcome of the indirect pancreatic function tests during enzyme supplementation was much less and remained well below that of healthy volunteers (P < 0.05).
  
  
  CONCLUSIONS
  In cases of exocrine pancreatic insufficiency after Whipple's procedure, 2-mm ECPM treatment adequately restores pancreatic enzyme activity. Following PPPD, however, ECPM treatment is often ineffective because the microspheres are retained in the stomach. In these patients, use of conventional powdered pancreatin enzyme preparations may improve the efficacy of treatment.
authors.affiliation: Division of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Bruno
authors.forename: J J
authors.initials: JJ
authors.lastname: Borm
authors.forename: F J
authors.initials: FJ
authors.lastname: Hoek
authors.forename: B
authors.initials: B
authors.lastname: Delzenne
authors.forename: A F
authors.initials: AF
authors.lastname: Hofmann
authors.forename: J J
authors.initials: JJ
authors.lastname: de Goeij
authors.forename: E A
authors.initials: EA
authors.lastname: van Royen
authors.forename: T M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: L T
authors.initials: LT
authors.lastname: de Wit
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: D J
authors.initials: DJ
authors.lastname: van Leeuwen
authors.forename: G N
authors.initials: GN
authors.lastname: Tytgat
mesh_terms: D010129:4-Aminobenzoic Acid / Q000378:metabolism; D000368:Aged; D001944:Breath Tests; D002788:Cholesterol Esters / Q000378:metabolism; D010188:Exocrine Pancreatic Insufficiency / Q000201:enzymology / Q000628:therapy*; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D005772:Gastrointestinal Transit; D006801:Humans; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010194:Pancreatin / Q000008:administration & dosage* / Q000493:pharmacokinetics; D062366:para-Aminobenzoates
chemical_list: D002788:Cholesterol Esters; D005765:Gastrointestinal Agents; D062366:para-Aminobenzoates; C053743:cholesteryl octanoate; C006717:bentiromide; D010194:Pancreatin; D010129:4-Aminobenzoic Acid