Is pyloric function preserved in pylorus-preserving pancreaticoduodenectomy?

OBJECTIVE

To assess the function of the pylorus after pylorus-preserving pancreaticoduodenectomy (PPPD) done for periampullary or pancreatic cancer.

DESIGN

Prospective, observational controlled clinical study.

SETTING

Teaching hospital, Italy.

SUBJECTS

17 patients who had undergone PPPD, and 15 healthy control subjects.

INVESTIGATIONS

Endoscopy to check for gastritis and marginal ulcers and 24 h-pH monitoring and 99mTc HIDA scintigraphy to detect jejunogastric reflux. Scintigraphy was also used to evaluate gastric and jejunal transit after a solid meal labelled with 99mTc colloid sulphur.

MAIN OUTCOME MEASURES

Signs of delayed gastric emptying, jejunogastric reflux and gastric outlet obstruction in the short and long term.

RESULTS

In the early postoperative period only 1 patient had delayed gastric emptying. In the long term, two patients had symptoms of dyspepsia and 8/11 showed alkaline reflux with persistent gastric pH more than 4 for more than 12 hours; 3 had histological signs of gastritis. There was no difference in gastric emptying compared with controls, but three patients had prolonged emptying time (T1/2 more than 85 minutes). Endoscopy findings correlated with pH monitoring results.

CONCLUSIONS

After PPPD, most patients have abnormal pyloric function, but it is clinically evident in only a small proportion.