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. 1999 Feb;229(2):223–229. doi: 10.1097/00000658-199902000-00010

Delayed gastric emptying after Billroth I pylorus-preserving pancreatoduodenectomy: effect of postoperative time and cisapride.

T Takeda 1, J Yoshida 1, M Tanaka 1, H Matsunaga 1, K Yamaguchi 1, K Chijiiwa 1
PMCID: PMC1191635  PMID: 10024104

Abstract

OBJECTIVE: To study the recovery course of gastric emptying after Billroth I pylorus-preserving pancreatoduodenectomy (PPPD) and therapeutic effects of cisapride. METHODS: To examine gastric emptying, acetaminophen was given, admixed in a pasty liquid meal, to 16 patients undergoing PPPD before surgery and at 1, 3, 6, 9, and 12 months after surgery. Cisapride was given orally to 10 patients before they received the acetaminophen regimen. Electrogastrography was performed at 2 weeks to 1 month after surgery in eight patients and at 6 to 12 months after surgery in seven patients. RESULTS: Gastric emptying was delayed but returned to the preoperative level by 6 months after surgery. Pretreatment with cisapride accelerated gastric emptying during months 1 to 6 but not during months 6 to 12 after surgery. Electrogastrography frequently showed tachygastria 2 weeks to 1 month after surgery, but seldom 6 to 12 months after surgery. CONCLUSIONS: After Billroth I PPPD, gastric emptying is delayed but recovers by 6 months after surgery. Tachygastria may play a part in the pathogenesis of delayed gastric emptying, but it can be treated with cisapride.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arnold J. H., Alevizatos C. A., Cox S. E., Richards W. O. Propagation of small bowel migrating motor complex activity fronts varies with anastomosis type. J Surg Res. 1991 Dec;51(6):506–511. doi: 10.1016/0022-4804(91)90173-j. [DOI] [PubMed] [Google Scholar]
  2. Barkin J. S., Goldberg R. I., Sfakianakis G. N., Levi J. Pancreatic carcinoma is associated with delayed gastric emptying. Dig Dis Sci. 1986 Mar;31(3):265–267. doi: 10.1007/BF01318117. [DOI] [PubMed] [Google Scholar]
  3. Braasch J. W., Deziel D. J., Rossi R. L., Watkins E., Jr, Winter P. F. Pyloric and gastric preserving pancreatic resection. Experience with 87 patients. Ann Surg. 1986 Oct;204(4):411–418. doi: 10.1097/00000658-198610000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Camilleri M., Malagelada J. R., Abell T. L., Brown M. L., Hench V., Zinsmeister A. R. Effect of six weeks of treatment with cisapride in gastroparesis and intestinal pseudoobstruction. Gastroenterology. 1989 Mar;96(3):704–712. [PubMed] [Google Scholar]
  5. Clements J. A., Heading R. C., Nimmo W. S., Prescott L. F. Kinetics of acetaminophen absorption and gastric emptying in man. Clin Pharmacol Ther. 1978 Oct;24(4):420–431. doi: 10.1002/cpt1978244420. [DOI] [PubMed] [Google Scholar]
  6. Corinaldesi R., Stanghellini V., Raiti C., Rea E., Salgemini R., Barbara L. Effect of chronic administration of cisapride on gastric emptying of a solid meal and on dyspeptic symptoms in patients with idiopathic gastroparesis. Gut. 1987 Mar;28(3):300–305. doi: 10.1136/gut.28.3.300. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Edwards C. A., Holden S., Brown C., Read N. W. Effect of cisapride on the gastrointestinal transit of a solid meal in normal human subjects. Gut. 1987 Jan;28(1):13–16. doi: 10.1136/gut.28.1.13. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Flautner L., Tihanyi T., Szécsény A. Pancreatogastrostomy: an ideal complement to pancreatic head resection with preservation of the pylorus in the treatment of chronic pancreatitis. Am J Surg. 1985 Nov;150(5):608–611. doi: 10.1016/0002-9610(85)90446-5. [DOI] [PubMed] [Google Scholar]
  9. Geldof H., van der Schee E. J., van Blankenstein M., Smout A. J., Akkermans L. M. Effects of highly selective vagotomy on gastric myoelectrical activity. An electrogastrographic study. Dig Dis Sci. 1990 Aug;35(8):969–975. doi: 10.1007/BF01537245. [DOI] [PubMed] [Google Scholar]
  10. Grace P. A., Pitt H. A., Longmire W. P. Pylorus preserving pancreatoduodenectomy: an overview. Br J Surg. 1990 Sep;77(9):968–974. doi: 10.1002/bjs.1800770906. [DOI] [PubMed] [Google Scholar]
  11. Grace P. A., Pitt H. A., Tompkins R. K., DenBesten L., Longmire W. P., Jr Decreased morbidity and mortality after pancreatoduodenectomy. Am J Surg. 1986 Jan;151(1):141–149. doi: 10.1016/0002-9610(86)90024-3. [DOI] [PubMed] [Google Scholar]
  12. Heading R. C., Nimmo J., Prescott L. F., Tothill P. The dependence of paracetamol absorption on the rate of gastric emptying. Br J Pharmacol. 1973 Feb;47(2):415–421. doi: 10.1111/j.1476-5381.1973.tb08339.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hocking M. P., Harrison W. D., Sninsky C. A. Gastric dysrhythmias following pylorus-preserving pancreaticoduodenectomy. Possible mechanism for early delayed gastric emptying. Dig Dis Sci. 1990 Oct;35(10):1226–1230. doi: 10.1007/BF01536411. [DOI] [PubMed] [Google Scholar]
  14. Horowitz M., Maddox A., Harding P. E., Maddern G. J., Chatterton B. E., Wishart J., Shearman D. J. Effect of cisapride on gastric and esophageal emptying in insulin-dependent diabetes mellitus. Gastroenterology. 1987 Jun;92(6):1899–1907. doi: 10.1016/0016-5085(87)90622-6. [DOI] [PubMed] [Google Scholar]
  15. Hunt D. R., McLean R. Pylorus-preserving pancreatectomy: functional results. Br J Surg. 1989 Feb;76(2):173–176. doi: 10.1002/bjs.1800760223. [DOI] [PubMed] [Google Scholar]
  16. IMANAGA H. A new method of pancreaticoduodenectomy designed to preserve liver and pancreatic function. Surgery. 1960 Apr;47:577–586. [PubMed] [Google Scholar]
  17. Itani K. M., Coleman R. E., Meyers W. C., Akwari O. E. Pylorus-preserving pancreatoduodenectomy. A clinical and physiologic appraisal. Ann Surg. 1986 Dec;204(6):655–664. doi: 10.1097/00000658-198612000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kreiss C., Schwizer W., Erlacher U., Borovicka J., Löchner-Kuery C., Müller R., Jansen J. B., Fried M. Role of antrum in regulation of pancreaticobiliary secretion in humans. Am J Physiol. 1996 May;270(5 Pt 1):G844–G851. doi: 10.1152/ajpgi.1996.270.5.G844. [DOI] [PubMed] [Google Scholar]
  19. Lux G., Lederer P., Ellermann A. Antroduodenale Koordination. Z Gastroenterol. 1986 Sep;24 (Suppl 2):55–61. [PubMed] [Google Scholar]
  20. Matsunaga H., Tanaka M., Naritomi G., Yokohata K., Yamaguchi K., Chijiwa K. Effect of leucine 13-motilin (KW5139) on early gastric stasis after pylorus-preserving pancreatoduodenectomy. Ann Surg. 1998 Apr;227(4):507–512. doi: 10.1097/00000658-199804000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Medhus A., Sandstad O., Bredesen J., Husebye E. The migrating motor complex modulates intestinal motility response and rate of gastric emptying of caloric meals. Neurogastroenterol Motil. 1995 Mar;7(1):1–8. doi: 10.1111/j.1365-2982.1995.tb00202.x. [DOI] [PubMed] [Google Scholar]
  22. Milligan K. R., Howe J. P., McClean E., Dundee J. W. Postoperative gastric emptying in outpatient anesthesia: the effect of opioid supplementation. J Clin Anesth. 1988;1(1):9–11. doi: 10.1016/0952-8180(88)90004-9. [DOI] [PubMed] [Google Scholar]
  23. Moossa A. R. Surgical treatment of chronic pancreatitis: an overview. Br J Surg. 1987 Aug;74(8):661–667. doi: 10.1002/bjs.1800740803. [DOI] [PubMed] [Google Scholar]
  24. Mushambi M. C., Rowbotham D. J., Bailey S. M. Gastric emptying after minor gynaecological surgery. The effect of anaesthetic technique. Anaesthesia. 1992 Apr;47(4):297–299. doi: 10.1111/j.1365-2044.1992.tb02167.x. [DOI] [PubMed] [Google Scholar]
  25. Naritomi G., Tanaka M., Matsunaga H., Yokohata K., Ogawa Y., Chijiiwa K., Yamaguchi K. Pancreatic head resection with and without preservation of the duodenum: different postoperative gastric motility. Surgery. 1996 Nov;120(5):831–837. doi: 10.1016/s0039-6060(96)80091-2. [DOI] [PubMed] [Google Scholar]
  26. Nimmo W. S., Wilson J., Prescott L. F. Narcotic analgesics and delayed gastric emptying during labour. Lancet. 1975 Apr 19;1(7912):890–893. doi: 10.1016/s0140-6736(75)91687-6. [DOI] [PubMed] [Google Scholar]
  27. Pfaffenbach B., Adamek R. J., Kuhn K., Wegener M. Electrogastrography in healthy subjects. Evaluation of normal values, influence of age and gender. Dig Dis Sci. 1995 Jul;40(7):1445–1450. doi: 10.1007/BF02285190. [DOI] [PubMed] [Google Scholar]
  28. Richards R. D., Valenzuela G. A., Davenport K. G., Fisher K. L., McCallum R. W. Objective and subjective results of a randomized, double-blind, placebo-controlled trial using cisapride to treat gastroparesis. Dig Dis Sci. 1993 May;38(5):811–816. doi: 10.1007/BF01295905. [DOI] [PubMed] [Google Scholar]
  29. Schuurkes J. A., Van Nueten J. M., Van Daele P. G., Reyntjens A. J., Janssen P. A. Motor-stimulating properties of cisapride on isolated gastrointestinal preparations of the guinea pig. J Pharmacol Exp Ther. 1985 Sep;234(3):775–783. [PubMed] [Google Scholar]
  30. Stoddard C. J., Smallwood R. H., Duthie H. L. Electrical arrhythmias in the human stomach. Gut. 1981 Sep;22(9):705–712. doi: 10.1136/gut.22.9.705. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Takada T., Yasuda H., Shikata J., Watanabe S., Shiratori K., Takeuchi T. Postprandial plasma gastrin and secretin concentrations after a pancreatoduodenectomy. A comparison between a pylorus-preserving pancreatoduodenectomy and the Whipple procedure. Ann Surg. 1989 Jul;210(1):47–51. doi: 10.1097/00000658-198907000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Traverso L. W., Longmire W. P., Jr Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet. 1978 Jun;146(6):959–962. [PubMed] [Google Scholar]
  33. Ueno T., Tanaka A., Hamanaka Y., Tsurumi M., Suzuki T. A proposal mechanism of early delayed gastric emptying after pylorus preserving pancreatoduodenectomy. Hepatogastroenterology. 1995 Jul;42(3):269–274. [PubMed] [Google Scholar]
  34. Warshaw A. L., Torchiana D. L. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy. Surg Gynecol Obstet. 1985 Jan;160(1):1–4. [PubMed] [Google Scholar]
  35. Williamson R. C., Bliouras N., Cooper M. J., Davies E. R. Gastric emptying and enterogastric reflux after conservative and conventional pancreatoduodenectomy. Surgery. 1993 Jul;114(1):82–86. [PubMed] [Google Scholar]
  36. Wulschke S., Ehrlein H. J., Tsiamitas C. The control mechanisms of gastric emptying are not overridden by motor stimulants. Am J Physiol. 1986 Dec;251(6 Pt 1):G744–G751. doi: 10.1152/ajpgi.1986.251.6.G744. [DOI] [PubMed] [Google Scholar]
  37. Yeo C. J., Barry M. K., Sauter P. K., Sostre S., Lillemoe K. D., Pitt H. A., Cameron J. L. Erythromycin accelerates gastric emptying after pancreaticoduodenectomy. A prospective, randomized, placebo-controlled trial. Ann Surg. 1993 Sep;218(3):229–238. doi: 10.1097/00000658-199309000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. van Wyk M., Sommers D. K., Moncrieff J. Influence of cisapride, metoclopramide and loperamide on gastric emptying of normal volunteers as measured by means of the area under the curve of the cumulative fraction absorbed-time profiles of paracetamol. Methods Find Exp Clin Pharmacol. 1992 Jun;14(5):379–382. [PubMed] [Google Scholar]
  39. van Wyk M., Sommers D. K., Snyman J. R., Moncrieff J. A foreshortened method of measuring liquid gastric emptying in normal volunteers. Methods Find Exp Clin Pharmacol. 1993 Jan-Feb;15(1):61–66. [PubMed] [Google Scholar]

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