IMPACT OF RESECTION OR DUCT DRAINAGE ON G LUCOSE-STIMULATED BETA-CELLFUNCTION IN CHRONIC-PANCREATITIS

Chronic pancreatitis (CP) leads to deterioration of the endocrine panc reatic function by fibrotic destruction. The aim of the present study was to investigate whether resection or duct drainage in patients with CP would have a direct impact on the pancreatic beta cell function. A n intravenous glucose tolerance test (IVGTT) was performed before, aft er and in some cases 3 months after operation in ten patients each of whom had been treated by either resection or duct drainage. Three pati ents undergoing pancreatic resection for cancer served as controls. Be ta cell function was assessed by glucose elimination K-values), insuli n and C-peptide response. K-Values in patients with CP were not signif icantly influenced after resection (1.93 +/- 0.78/2.13 +/- 0.72; n.s.) or drainage (1.26 +/- 0.47/1.54 +/- 0.58; n.s.) but reduced in all th ree tumor patients (2.23 +/- 0.55/1.23 +/- 0.43). The initial insulin response [[mu U/ml] in CP patients was also not altered after resectio n (19.7 +/- 17.3/16.0 +/- 18.2; n.s.) or after drainage (16.7 +/- 16.5 /13.0 +/- 9.0; n.s.), whereas all three resected tumor patients showed reduced values (42.9 +/- 15.7/17.5 +/- 3.8). Stimulated C-peptide syn thesis [ngmin/ml] was not substantially lowered in patients resected f or CP (90.5 +/- 85.6/73.8 +/- 48.9; n.s.) or in the drainage group (12 1.3 +/- 67.5/98.0 +/- 57.2; n.s.), but this parameter was decreased in every tumor patient postoperatively (157.8 +/- 66.9/125.1 +/- 69.6). Resection in patients with chronic pancreatitis did not inevitably res ult in loss of beta cell function. Parenchyma-preserving drainage proc edures had no measurable advantage in this respect. Therefore, the tec hnique must be individually chosen in surgical therapy of chronic panc reatitis, depending on intention of treatment, appropriate organ morph ology, and the long-term success rate of the procedure.