PANCREATIC-ENZYME ACTIVITY AFTER A PYLORUS-PRESERVING PANCREATICODUODENECTOMY RECONSTRUCTED WITH PANCREATICOGASTROSTOMY

This study was initiated to clarify whether the main hydrolytic enzyme s of the pancreas are activated or inactivated when secreted into the stomach of patients who had undergone a pylorus-preserving pancreatico duodenectomy (PPPD) and were given a pancreaticogastrostomy (PG) for t he reconstruction. Seventeen such patients, 15 cancer patients and two pancreatitis patients, who underwent PPPD-PG reconstruction were post operatively followed up for 3 or more years to investigate the influen ce of the gastric acid on the p-type amylase and lipase activity. Resu lts revealed that when the pH was <3.0, both the p-type amylase and th e lipase secretion remained inactivated, but when the pH was >3.1, the activity of both enzymes increased proportionately. The pancreatic en zyme activity in the small intestine was also investigated in seven pa tients, 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 feca l pancreatic enzyme activity was investigated in 17 patients given a P PPD-PG reconstruction. Results reveal that the fecal p-type amylase, l ipase, and chymotrypsin activity amounted to 21, 27, and 31% of the re spective values seen in 10 healthy volunteers. However, the fecal panc reatic enzyme activity levels did not differ significantly from the le vels seen in 20 pancreaticoduodenectomy patients given a pancreaticoje junostomy reconstruction. In conclusion, it was found that the main hy drolytic enzymes of the pancreas are activated when the gastric acidit y is over pH 3.1, which normally occurs after ingestion of a meal.