title: A safe and noninvasive test for vagal integrity revisited.
abstract: OBJECTIVE
  Measurement of pancreatic polypeptide (PP) response to sham feeding and pharmacological stimulation is a safe, noninvasive, and sensitive test for vagal integrity.
  
  
  METHODS
  Interventional study with control arms.
  
  
  METHODS
  Tertiary center for esophageal surgery.
  
  
  METHODS
  Thirty healthy volunteers and 25 patients who underwent total esophagectomy formed the control group with intact vagi and known vagotomy, respectively.
  
  
  METHODS
  Blood samples were obtained 15 minutes before and immediately before sham feeding to determine basal PP levels. Samples were also obtained 15, 30, 45, and 60 minutes after the sham feeding and 10 and 20 minutes after administration of 5 mg of intravenous edrophonium hydrochloride.
  
  
  METHODS
  Pancreatic polypeptide response to sham feeding and edrophonium administration were compared in both groups and the optimal percentage of rise from basal levels with maximal sensitivity and specificity was determined.
  
  
  RESULTS
  Basal levels were similar in both groups (50 vs 45 ng/L). The maximum percentage of rise within 30 minutes after sham feeding was significantly higher in healthy subjects than in patients who underwent vagotomy (P<.001). A rise of 50% was seen in 24 (83%) of the 29 healthy subjects vs 2 (8%) of the 25 patients who underwent vagotomy (P<.001). This rise in PP level had a sensitivity of 83%, specificity of 92%, and a positive predictive value of 92% for identifying an intact vagus. The administration of endrophonium did not improve these results.
  
  
  CONCLUSIONS
  A rise of more than 50% in the PP level within 30 minutes of sham feeding is a strong indicator of vagal integrity. This test has the potential to investigate vagal injury after gastroesophageal surgery.
authors.affiliation: Department of Surgery, University of Southern California, Los Angeles, CA 90033, USA.
authors.forename: Nagammapudur S
authors.initials: NS
authors.lastname: Balaji
authors.forename: Peter F
authors.initials: PF
authors.lastname: Crookes
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Banki
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Hagen
authors.forename: Joy E
authors.initials: JE
authors.lastname: Ardill
authors.forename: Tom R
authors.initials: TR
authors.lastname: DeMeester
mesh_terms: D000328:Adult; D000368:Aged; D002800:Cholinesterase Inhibitors; D004435:Eating / Q000502:physiology*; D004491:Edrophonium; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010191:Pancreatic Polypeptide / Q000097:blood / Q000378:metabolism*; D012372:ROC Curve; D011863:Radioimmunoassay; D014628:Vagotomy; D014630:Vagus Nerve / Q000502:physiology* / Q000503:physiopathology
chemical_list: D002800:Cholinesterase Inhibitors; D010191:Pancreatic Polypeptide; D004491:Edrophonium