Quantitative evaluation of reconstruction methods after gastrectomy using a new type of examination: digestion and absorption test with stable isotope 13C-labeled lipid compound.
BACKGROUND
Digestive and absorptive disorders may negatively influence patients' nutrition, thus resulting in weight loss after gastrectomy. A relationship thus seems to exist between the fat absorptive function and body weight after gastrectomy; however, so far there has been no evidence to prove this hypothesis. Therefore, in this study we evaluated fat absorption ability using a stable isotope, (13)C-trioctanoin, based on the range of the gastrectomy and the method of reconstruction, and we also determined the feasibility of this test.


METHODS
Among patients who had undergone gastrectomy for gastric cancer, 40 patients who had been operated on between 1 and 3 years previously were evaluated. Ten patients had undergone the double-tract (DT) method, and 10 patients had received the Roux-en-Y (RY) method after a total gastrectomy. Twenty patients who had undergone the Billroth I (BI) method after a distal gastrectomy were the control group. In addition, 10 volunteers formed a healthy control group for the (13)C-trioctanoin test. We also examined other six factors related to nutrition after gastrectomy. RESULTS. The (13)C-trioctanoin test showed, in relation to the reconstruction procedure, the highest average peak of fat absorption in the BI group (which had food passage through the duodenum), followed by the average peak of fat absorption in the DT group and the RY groups. In a comparison of duration, at 60 min and 90 min after administration, the BI group and DT group showed a significantly higher level than the RY group. The peaking time (average time at peak level) showed a significant difference between the RY group and the other groups. The absorption amount at an early stage of absorption and the percent (%) dose showed a significant difference between the RY group and the other groups. The RY group had significantly lower fat absorption than the healthy controls.


CONCLUSIONS
According to this study, which evaluated fat absorption after different reconstructive procedures after gastrectomy, the procedure that accommodated for the passage of food through the duodenum showed better results for the absorption of medium-chain triglycerides, and the patients also showed a better physiological state.
Takase
Makoto
M
The Third Department of Surgery, Toho University School of Medicine, Ohashi Hospital, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-8515, Japan.
Sumiyama
Yoshinobu
Y
Nagao
Jiro
J
D000368:Aged; D000713:Anastomosis, Roux-en-Y; D001835:Body Weight; D002210:Caprylates; D002247:Carbon Isotopes; D016022:Case-Control Studies; D004041:Dietary Fats / Q000493:pharmacokinetics*; D004063:Digestion; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects; D005951:Glucose Tolerance Test; D006801:Humans; D007408:Intestinal Absorption; D008286:Malabsorption Syndromes / Q000517:prevention & control; D008297:Male; D044342:Malnutrition / Q000517:prevention & control; D008875:Middle Aged; D010186:Pancreatic Function Tests; D011178:Postgastrectomy Syndromes / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013274:Stomach Neoplasms / Q000601:surgery; D014280:Triglycerides
D002210:Caprylates; D002247:Carbon Isotopes; D004041:Dietary Fats; D014280:Triglycerides; C003637:tricaprylin