EFFECT OF LEUCINE 13-MOTILIN (KW5139) ON EARLY GASTRIC STASIS AFTER PYLORUS-PRESERVING PANCREATICODUODENECTOMY

Objective To test a hypothesis that exogenously administered motilin w ould improve early gastric stasis after pylorus-preserving pancreatodu odenectomy (PPPD). Summary Background Data Prolonged gastric stasis is a frequent complication after PPPD. We demonstrated that this might a t least in part be attributable to delayed recovery of phase III activ ity of the gastric migrating motor complex due to low concentrations o f plasma motilin caused by resection of the duodenum. Methods Ten pati ents with a mean age of 54 years (range, 33-70) who underwent PPPD wer e studied. An assembly of manometric tubes was placed in the gastric a ntrum and jejunum (neoduodenum) at surgery. A gastrostomy tube was add ed for drainage and volume measurements of the gastric juice. After ba seline recording, saline as a placebo was given intravenously on day 1 4 and 0.5 mu g/kg of KW5139 (leucine-13 motilin) was given on days 17 and 18 every 2 hours, a times a day. The daily volume of gastric juice output and a gastric motility index were measured. Results The mean p eriod until the first appearance of phase III activity in the stomach was 41 +/- 2 days. The injection of saline did not change the gastric motility index (7.3 +/- 1.1 to 7.1 +/- 1.3 mmHg; p = 0.72). In contras t, motilin resulted in a significant increase in the gastric motility index (7.5 +/- 1.0 to 17.7 +/- 2.0 mmHg; p < 0.001). The saline inject ion produced no change in the daily gastric juice output (1175 +/- 140 to 1393 +/- 193 mL; p = 0.09). Motilin significantly decreased the ga stric juice output (1387 +/- 157 to 934 +/- 142 mL; p = 0.01). Conclus ions These data indicate that KW5139 is a safe and effective prokineti c drug for the treatment of early gastric stasis after PPPD.