Permeability and functionality of pancreaticogastrostomy after pancreaticoduodenectomy with dynamic magnetic resonance pancreatography after secretin stimulation.
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.
Pessaux
Patrick
P
Department of Visceral Surgery, Chu Angers, Hôpital La Pitié Salpétrière, Paris, France.
Aube
Christophe
C
Lebigot
Jérome
J
Tuech
Jean-Jacques
JJ
Regenet
Nicolas
N
Kapel
Nathalie
N
Caron
Christine
C
Arnaud
Jean-Pierre
JP
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
D012633:Secretin