Pancreatic enzyme activity after a pylorus-preserving pancreaticoduodenectomy reconstructed with pancreaticogastrostomy

Abstract

This study was initiated to clarify whether the main hydrolytic enzymes of the pancreas are activated or inactivated when secreted into the stomach of patients who had undergone a pylorus-preserving pancreaticoduodenectomy (PPPD) and were given a pancreaticogastrostomy (PG) for the reconstruction. Seventeen such patients, 15 cancer patients and two pancreatic patients, who underwent PPPD-PG reconstruction were postoperatively followed up for 3 or more years to investigate the influence of the gastric acid on the p-type amylase and lipase activity. Results revealed that when the pH was < 3.0, both the p-type amylase and the lipase secretion remained inactivated, but when the pH was > 3.1, the activity of both enzymes increased proportionately. The pancreatic enzyme activity in the small intestine was also investigated in seven patients, six cancer cases and one case of pancreatitis, given a PPPD-PG reconstruction, and it was found that the pancreatic enzyme activity in the small intestine increased after milk loading. Further, the fecal pancreatic enzyme activity was investigated in 17 patients given a PPPD-PG reconstruction. Results reveal that the fecal p-type amylase, lipase, and chymotrypsin activity amounted to 21, 27, and 31% of the respective values seen in 10 healthy volunteers. However, the fecal pancreatic enzyme activity levels did not differ significantly from the levels seen in 20 pancreaticoduodenectomy patients given a pancreaticojejunostomy reconstruction. In conclusion, it was found that the main hydrolytic enzymes of the pancreas are activated when the gastric acidity is over pH 3.1, which normally occurs after ingestion of a meal.