COMPARATIVE EFFECTS OF ENTERIC-COATED PANCREATIN MICROSPHERE THERAPY AFTER CONVENTIONAL AND PYLORUS-PRESERVING PANCREATICODUODENECTOMY

Background A comparative study was performed between patients with exo crine pancreatic insufficiency after conventional pancreatoduodenectom y (Whipple's procedure) and pylorus-preserving pancreatoduodenectomy ( PPPD). In these patients the pharmacodynamics of 2-mm enteric-coated p ancreatin microspheres (ECPMs) and their gastric transit time in relat ion to that of a solid meal were investigated. The efficacy of ECPM pr eparations may differ after Whipple's procedure compared with PPPD, be cause the latter procedure does not include gastrectomy.Methods Gastri c transit was assessed by double-isotope scintigraphy. A pancake meal was labelled with Tc-99m. ECPMs were cold-labelled with Er-170 and neu tron activated shortly before ingestion to enable imaging with a gamma camera. Intraluminal pancreatic enzyme activity was assessed during a 6-h period with two indirect tests: the cholesteryl [C-14]octanoate b reath test and the N-benzoyl-L-tyrosyl-p-aminobenzoic acid-p-aminosali cylic acid (NBT-PABA-PAS) test. Results In patients who had Whipple's procedure, the gastric transit time of ECPMs and of the pancake meal w as not significantly different. The outcome of the indirect pancreatic function tests during enzyme supplementation was comparable, and not significantly different, from that in healthy volunteers. In patients who had PPPD, however, the gastric transit time of microspheres was gr eatly delayed compared with that of the pancake meal (P < 0.05). Impro vement in the outcome of the indirect pancreatic function tests during enzyme supplementation was much less and remained well below that of healthy volunteers (P < 0.05). Conclusion In cases of exocrine pancrea tic insufficiency after Whipple's procedure, 2-mm ECPM treatment adequ ately restores pancreatic enzyme activity. Following PPPD, however, EC PM treatment is often ineffective because the microspheres are retaine d in the stomach. In these patients, use of conventional powdered panc reatin enzyme preparations may improve the efficacy of treatment.