Abstract
This prospective study was undertaken to determine the, effect of partial gastrectomy without vagotomy on postprandial gallbladder contraction and secretion of cholecystokinin (CCK) and pancreatic polypeptide (PP) in 22 peptic ulcer patients randomly assigned to either Billroth II (N=11) or Roux-en-Y (N=11) anastomosis. The patients were studied within two weeks before surgery and at six months postoperatively. After surgery basal gallbladder volumes were larger than preoperatively (P < 0.02). Integrated postprandial gallbladder contraction was not significantly affected by gastrectomy, either in the patients with Billroth II anastomosis (2276±268 vs 1985±362%/60 min) or in those with Roux-en-Y anastomosis (2045±327 vs 2445±352%/60 min) when studied pre- and postoperatively, respectively. Similarly, integrated postprandial plasma CCK secretion was not significantly changed by either Billroth II gastrectomy (200±31 vs 166±21 pM/60 min) or Roux-en-Y gastrectomy (146±26 vs 147±12 pM/60 min). However, integrated postprandial PP secretion was significantly (P < 0.05) lower after Billroth II gastrectomy (6.8±2.4 vs 2.2±1.0 nM/60 min), while the reduction in plasma PP after Roux-en-Y gastrectomy just failed to reach statistical significance (6.0±1.5 vs 3.4±0.9 nM/60 min). Similarly, the PP response, but not the gallbladder response, to an intravenous bolus injection of 1 IDU CCK/kg body weight was significantly decreased after gastrectomy independent of the type of anastomosis. It is concluded that gastrectomy does not affect postprandial plasma CCK secretion and gallbladder contraction, but reduces the PP response to a mixed meal and that these results are not influenced by the type of anastomosis. It is possible that the larger postoperative gallbladder volumes may play a role in the pathogenesis of gallstone disease after gastric surgery.
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Majoor CLH, Suren TJJ: Gallbladder complications following resection of stomach for peptic ulcer. Br Med J 2:8–11, 1947
Turunen M, Antila L: Gallbladder disease following gastrectomy. Acta Chir Scand 127:134–137, 1964
Griffiths JMT, Holmes G: Cholecystitis following gastric surgery. Lancet 2:780–782, 1964
Fletcher DM, Clark CG: Gallstones and gastric surgery. A review. Br J Surg 55:895–899, 1968
Horwitz A, Kirson SM: Cholecystitis and cholelithiasis as a sequel to gastric surgery. A clinical impression. Am J Surg 109:760–762, 1965
Lorusso D, Misciagna G, Noviello MR, Tarantino S: Cholelithiasis after Billroth II gastric resection. Surgery 103:579–583, 1988
Inoue K, Fuchigami A, Hosotani R, Kogire M, Huang Y-S, Miyashita T, Suzuki T, Tsuda K, Seino Y, Rayford PL, Thompson JC, Tobe T: Release of cholecystokinin and gallbladder contraction before and after gastrectomy. Ann Surg 205:27–32, 1987
Rieu PNMA, Jansen JBMJ, Joosten HJM, Biemond I, Yap SH, Lamers CBHW: Prospective comparison of gastric secretory function after gastrectomy with either Billroth-II or Roux-en-Y anastomosis. Surgery 105:331–336, 1989
Biemond I, Rieu PNMA, Jansen JBMJ, Joosten HJM, Lamers CBHW: Prospective study on the effect of gastrectomy with and without bile reflux on serum pepsinogens. Digestion 44:124–130, 1989
Rieu PNMA, van Kroonenburgh MJPG, Jansen JBMJ, Joosten HJM, Lamers CBHW: Gastric emptying after partial gastrectomy without vagotomy with primary Roux-en-Y or Billroth II anastomosis. Nucl Med Commun 10:715–722, 1989
Offerhaus GJA, Rieu PNMA, Jansen JBMJ, Joosten HJM, Lamers CBHW: Prospective comparative study on the influence of postoperative bile reflux on gastric mucosal histology and campylobacter pylori infection. Gut 30:1552–1557, 1989
Rieu PNMA, Jansen JBMJ, Joosten HJM, Lamers CBHW: Effect of gastrectomy with either Roux-en-Y or Billroth-II anastomosis on small intestinal function. Scand J Gastroenterol 25:185–192, 1990
Langhans P, Schönleben K, Bünte H. The routine use of Roux-en-Y anastomosis in gastric surgery. Scand J Gastroenterol 16(suppl 67):247–249, 1981
Bünte H. Syndrome nach Resektion und Gastrektomie. Langenbecks Arch Chir 358:95–100, 1982
Mättig H, Schneider G, Wiesenhaken U, Wohlgemuth B, Goerl R: Ergebnisse nach refluxfreier Magenresektion meit Y-Roux-Anastomose beim Gastroduodenalulkus. Zentralbl Chir 112:303–311, 1987
Hopman WPM, Brouwer WFM, Rosenbusch G, Jansen JBMJ, Lamers CBHW: A computerized method for rapid quantification of gallbladder volume from real-time sonographs. Radiology 154:236–237, 1985
Hopman, WPM, Kerstens PJSM, Jansen JBMJ, Rosenbusch G, Lamers CBHW: Effect of graded physiological doses of cholecystokinin on gallbladder contraction measured by ultrasonography; determination of threshold, dose-response relationships and comparison with intraduodenal bilirubin output. Gastroenterology 89:1242–1247, 1985
Jansen JBMJ, Lamers CBHW: Radioimmunoassy of cholecystokinin in human tissue and plasma. Clin Chim Acta 131:305–316, 1983
Jansen JBMJ, Lamers CBHW: Molecular forms of cholecystokinin in plasma from normal and gastrectomized human subjects following a fat meal. Peptides 8:801–806, 1987
Lamers CBHW, Diemel JM, van Leer E, van Leusen R, Peetoom J: Mechanism of elevated serum pancreatic polypeptide concentrations in chronic renal failure. J Clin Endocrinol Metab 55:922–926, 1982
Jebbink MCW, Ganai S, Jansen JBMJ, Lamers CBHW: Effects of pancreatic enzymes on postprandial CCK secretion and gallbladder contraction during treatment with CR 1505. Digestion 1990 (in press)
Hopman WPM, Jansen JBMJ, Rosenbusch G, Lamers CBHW: Gallbladder contraction by cholecystokinin: bolus injection or infusion? Br Med J 292:375–376, 1986
Hopman WPM, Jansen JBMJ, Lamers CBHW: Plasma cholecystokinin response to oral fat in patients with Billroth I and Billroth II gastrectomy. Ann Surg 199:276–280, 1984
Becker HD, Werner M, Schafmayer A: Release of radioimmunologic cholescystokinin in human subjects. Am J Surg 147:124–129, 1984
Satake K, Takeuchi T, Watanabe S, Nishiwaki H: Postprandial plasma cholecystokinin response in patients after gastrectomy and pancreatoduodenectomy. Am J Gastroenterol 81:1038–1042, 1986
Masclee AAM, Jansen JBMJ, Driessen WMM, Geuskens LM, Lamers CBHW: Role of the gastric phase in fat induced gallbladder contraction and cholecystokinin secretion in humans. Eur J Clin Invest 19:442–447, 1989
Lam SK: Pathogenesis and pathophysiology of duodenal ulcer. Clin Gastroenterol 13:447–472, 1984
Hopman WPM, Jansen JBMJ, Lamers CBHW: Plasma cholecystokinin response to a liquid fat meal in vagotomized patients. Ann Surg 200:693–697, 1984
Weiser JR, Wagner T: Effect of standardized diet on gallbladder function of patients with B II stomach resection. Gastroenterology 92:1690, 1987
Marzio L, DiFelice F, Caliberti V, DiGioacchino M, Mezzetti A, Cuccurullo F, Innocenti P: Gallbladder emtpying in duodenal ulcer patients having undergone Billroth II gastrectomy. Digestion 41:223–228, 1988
Taylor IL, Kauffman G, Walsh JH, Trout H, Chew P, Harmon J: Role of the small intestine and gastric antrum in pancreatic polypeptide release. Am J Physiol 240:G387-G391, 1981
Gomez G, Upp JR, Lluis F, Alexander RW, Poston GJ, Greeley JR, Thompson JC: Regulation of the release of cholecystokinin by bile salts in dogs and humans. Gastroenterology 94:1036–1046, 1988
Owyang C, Louie DS, Tatum D: Feedback regulation of pancreatic enzyme secretion. J Clin Invest 77:2042–2047, 1986
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Rieu, P.N.M.A., Jansen, J.B.M.J., Hopman, W.P.M. et al. Effect of partial gastrectomy with Billroth II or Roux-en-Y anastomosis on postprandial and cholecystokinin-stimulated gallbladder contraction and secretion of cholecystokinin and pancreatic polypeptide. Digest Dis Sci 35, 1066–1072 (1990). https://doi.org/10.1007/BF01537576
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DOI: https://doi.org/10.1007/BF01537576