Postprandial plasma cholecystokinin response in patients after gastrectomy and pancreatoduodenectomy.

Endogenous cholecystokinin release after a test meal was measured in the controls, patients with Billroth I and II anastomosis after subtotal gastrectomy, patients with a Roux-en-Y anastomosis after total gastrectomy, and patients with a modified Child's reconstruction after pancreatoduodenectomy 2 months after surgery. The postprandial plasma level in patients with Billroth I and II anastomosis was close to that in the controls. In a Roux-en-Y anastomosis, this level was slightly higher than in the controls and patients with a Billroth anastomosis. Differences in integrated cholecystokinin secretion at 120 min in different groups were insignificant. After a modified Child's reconstruction, the postprandial level was significantly lower than in the controls and in patients with a Billroth II anastomosis. One patient with a modified Child's reconstruction was examined 8 yr after surgery, and she had a normal response. We suggest that either the duodenum or jejunum used for gastrointestinal anastomosis can release cholecystokinin normally, and pancreatoduodenectomy may decrease cholecystokinin release 2 months after surgery.