title: Permeability and functionality of pancreaticogastrostomy after pancreaticoduodenectomy with dynamic magnetic resonance pancreatography after secretin stimulation.
abstract: BACKGROUND
  The aim of this study was to evaluate pancreatogastrostomy (PG) permeability after duodenopancreatectomy (PD) and to determine a correlation with pancreatic endocrine and exocrine functions.
  
  
  METHODS
  This prospective study included 19 patients who underwent PD with PG between 1992 and 1999. There were 12 men and 7 women, with a mean age of 58 years (range 35 to 76 years). The mean interval between operation and evaluation was 40.3 months (range 3 to 104 months). Indications for pancreatectomy were benign lesions (n = 13) or adenocarcinoma (n = 6). Histology of the pancreatic resection margin was normal in all patients with malignancy, and the pancreatic remnant was macroscopically normal without evidence of obstructive pancreatitis. Pancreatic exocrine and endocrine functions were respectively evaluated by fecal-1 elastase and fasting blood glucose concentrations. PG permeability was determined by secretin magnetic resonance cholangiopancreatography (Secretin-MRCP).
  
  
  RESULTS
  Anastomotic permeability was considered good in seven patients (group 1, 36.8%), moderately stenosed in six patients (group 2, 31.6%), significantly stenosed in four patients (group 3, 21.1%), and obstructed in two patients (group 4, 10.5%). Fecal-1 elastase concentration was decreased in 18 patients, with a mean concentration of 80 microg/g in group 1, 98 microg/g in group 2, 67 microg/g in group 3, and 0 microg/g in group 4. There was a statistically significant correlation between Secretin-MRCP group and fecal-1 elastase concentration. Results of fasting glucose estimation were normal for 14 of 19 patients. There was no correlation between pancreatic endocrine function and Secretin-MRCP group.
  
  
  CONCLUSIONS
  Exocrine pancreatic insufficiency was presented in 95% of the patients despite a PG permeability in 68.4%. These results may be explained in part by neutralization of pancreatic enzymatic secretions by gastric acid.
authors.affiliation: Department of Visceral Surgery, Chu Angers, Hôpital La Pitié Salpétrière, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
authors.forename: Christophe
authors.initials: C
authors.lastname: Aube
authors.forename: Jérome
authors.initials: J
authors.lastname: Lebigot
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Tuech
authors.forename: Nicolas
authors.initials: N
authors.lastname: Regenet
authors.forename: Nathalie
authors.initials: N
authors.lastname: Kapel
authors.forename: Christine
authors.initials: C
authors.lastname: Caron
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Arnaud
mesh_terms: D010188:Exocrine Pancreatic Insufficiency / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy; D006801:Humans; D007515:Islets of Langerhans / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000503:physiopathology*; D010182:Pancreatic Diseases / Q000601:surgery; D010183:Pancreatic Ducts / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy; D012633:Secretin; D013270:Stomach / Q000601:surgery*; D013997:Time Factors
chemical_list: D012633:Secretin