Artikel
Accelerated gastric emptying and GLP-1 release after pancreaticoduodenectomy: improved glycemic control after the Whipple procedure as compared to pylorus preservation
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Autoren
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Johannes Miholic
- Chirurgische Universitätsklinik, Allgemeinchirurgie, Wien
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Stefan Harmuth
- Chirurgische Universitätsklinik, Allgemeinchirurgie, Wien
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Marlene Wewalka
- Klinik für Innere Medizin III, Gastroenterologie und Hepatologie, Wien
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Jens Juul Holst
- Department of Medical Physiology, University of Copenhagen,, Panum Institute, Kopenhagen
| Veröffentlicht: | 26. April 2013 |
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Gliederung
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Introduction: Abnormal glucose regulation is highly prevalent in patients with pancreatic neoplasm. In these patients, partial pancreaticoduodenectomy can be carried out with pylorus preservation (PPPD) or with distal gastrectomy (Whipple procedure), which accelerates gastric emptying. Rapid gastric emptying enhances postprandial release of glucagon-like peptide-1 (GLP-1) which is known to improve glucose metabolism. Any procedure, if associated with accelerated gastric emptying might thus yield improved glycemic control. It was the purpose of this study to investigate the relationship between gastric emptying, GLP-1 and insulin sensitivity after pancreaticoduodenectomy.
Material and methods: A 75 g oral glucose tolerance test (OGTT) was carried out in 15 patients having undergone PPPD, and in 15 after Whipple procedure, following an interval of 31 (range, 5-199) months. Gastric emptying was measured by the paracetamol absorption method with the OGTT. Plasma concentrations of glucose, insulin, GLP-1, and paracetamol were measured at baseline, 10, 20, 30 60, 90, 120, 150, and 180 minutes.
Results: Patients with Whipple procedure as compared to PPPD had accelerated gastric emptying (p=0.03) which correlated closely with GLP-1 (AUC30; R=0.61; p=0.0003) and insulin sensitivity (R=0.41; p=0.026), and inversely with baseline glucose (R=0.36; p=0.049), and HbA1c (R=0.40; p=0.02). 6 of 15 Whipple patients (40%) and 7 of 15 after PPPD (47%) had postload glucose concentrations (i.e. 120 minutes at OGTT) ≥200 mg/dl (NS). After excluding the patients older than 70 none of eight (0%) after Whipple procedure but 7 of 13 (54%) after PPPD had postload glucose ≥200 mg/dl (p=0.018).
Conclusion: Gastric emptying was accelerated after Whipple procedure and correlated with GLP-1 release and insulin sensitivity which could explain the improvement of glycemic control frequently observed after pancreaticoduodenectomy. Parameters of glycemic control were significantly improved after the whipple procedure as compared to pylorus preservation.
