COMPARATIVE STUDY ON PANCREATIC EXOCRINE DYSFUNCTION AND THE CHANGES IN ENDOSCOPIC RETROGRADE PANCREATOGRAM IN POSTGASTRECTOMY PATIENTS

Abstract

It is generally accepted that pancreatic exocrine function disorders are seen in 10 to 20 per cent of postgastrectomy patients In this condition high amylase activities in the urine, increased amylase creatinine clearance ratio and derceased pancreatic exocrine function measured by the pancreozymin-secretin test were reported. The disorders were thought to be caused by the various damages to the pancreas which occured just after biliary or gastric surgery. The pancreatic exocrine dysfunction after gastrectomy showed an improvement with time and recovered nearly to the normal level by three to four months after surgery. In this study, endoscopic retrograde cholangiopancreatography (ERCP) was performed in 22 patients who underwent Billroth-I gastrectomy one to 20 years before this examination. The pancreatic exocrine function diagnostant (PFD) test, measurement of amylase activities in the urine and the serum, and gastric emptying test were also performed on the same patients. The results are summerized as follows: 1) Ten of 22 patients (45.5%) showed some changes in the pancreatic duct which resembled those of chronic pancreatitis. 2) The ductal pathology could be classified in to three different stages; “mild”, “mod-erate” and “severe” abnormality. In 10 patients with ductal changes, 5 showed “mild” 4 showed “moderate” and one showed “severe” change. 3) Four of 6 patients with abnormal pancreatic ducts on ERP showed abnormal values in the PFD test on the other hand only one of 7 with normal pancreatic ducts showed a slight decrease in the PFD test. Therefore, it is assumed that the patients with abnormal pancreatic ducts on ERP showed disorders of the pancreatic exocrine function. 4) The longer the duration of postgastrectomy state, the higher the incidence of ductal abnormality (P<0.025). 5) The gastric emptying was more rapid in the patients with “abnormal” pancreatic ducts than in those with “normal” pancreatic ducts. On the basis of these results in postgastrectomy patients, pancreaticocibal asynchrony may occur because of rapid gastric emptying and hypermotility of the small intestine. This condition may cause impairment of CCK-PZ and secretin secretion. Then, it is assumed that malabsorption due to pancreaticocibal asynchrony and reduced pancreatic exocrine function probably cause gradual pancreatic atrophy and / or fibrosis.