Effect of Leucine 13-motilin (KW5139) on Early Gastric Stasis After Pylorus-preserving Pancreatoduodenectomy

Overview

Journal Ann Surg

Specialty General Surgery

Date 1998 May 1

PMID 9563538

Citations 17

Authors

H Matsunaga

M Tanaka

G Naritomi

K Yokohata

K Yamaguchi

K Chijiwa

Affiliations

Soon will be listed here.

Abstract

Objective: To test a hypothesis that exogenously administered motilin would improve early gastric stasis after pylorus-preserving pancreatoduodenectomy (PPPD).

Summary Background Data: Prolonged gastric stasis is a frequent complication after PPPD. We demonstrated that this might at least in part be attributable to delayed recovery of phase III activity of the gastric migrating motor complex due to low concentrations of plasma motilin caused by resection of the duodenum.

Methods: Ten patients with a mean age of 54 years (range, 33-70) who underwent PPPD were studied. An assembly of manometric tubes was placed in the gastric antrum and jejunum (neoduodenum) at surgery. A gastrostomy tube was added for drainage and volume measurements of the gastric juice. After baseline recording, saline as a placebo was given intravenously on day 14 and 0.5 microg/kg of KW5139 (leucine-13 motilin) was given on days 17 and 18 every 2 hours, 6 times a day. The daily volume of gastric juice output and a gastric motility index were measured.

Results: The mean period 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 contrast, 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 injection produced no change in the daily gastric juice output (1175 +/- 140 to 1393 +/- 193 mL; p = 0.09). Motilin significantly decreased the gastric juice output (1387 +/- 157 to 934 +/- 142 mL; p = 0.01).

Conclusions: These data indicate that KW5139 is a safe and effective prokinetic drug for the treatment of early gastric stasis after PPPD.

Citing Articles

Early Oral Feeding with Vascular Resection among Patients Undergoing Pancreatoduodenectomy in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Regmee S, Limbu Y, Parajuli A, Ghimire R, Maharjan D, Shrestha S JNMA J Nepal Med Assoc. 2022; 60(246):177-182.

PMID: 35210628 PMC: 9200006. DOI: 10.31729/jnma.7272.

Antecolic reconstruction is associated with a lower incidence of delayed gastric emptying compared to retrocolic technique after Whipple or pylorus-preserving pancreaticoduodenectomy.

Qiu J, Li M, Du C Medicine (Baltimore). 2019; 98(34):e16663.

PMID: 31441841 PMC: 6716732. DOI: 10.1097/MD.0000000000016663.

Comparison of long-term benefits of organ-preserving pancreatectomy techniques for benign or low-grade malignant tumors at the pancreatic head.

Li Y, Wu W, Zhang T, Liao Q, Zhao Y, Dai M Medicine (Baltimore). 2018; 96(51):e9420.

PMID: 29390567 PMC: 5758269. DOI: 10.1097/MD.0000000000009420.

Does the Ileal Brake Contribute to Delayed Gastric Emptying After Pancreatoduodenectomy?.

Barreto S, Windsor J Dig Dis Sci. 2016; 62(2):319-335.

PMID: 27995402 DOI: 10.1007/s10620-016-4402-0.

Delayed Gastric Emptying after Pancreatic Surgery: Analysis of Factors Determinant for the Short-term Outcome.

NoorAni A, Rangelova E, Del Chiaro M, Lundell L, Ansorge C Front Surg. 2016; 3:25.

PMID: 27200357 PMC: 4843166. DOI: 10.3389/fsurg.2016.00025.

References

Traverso L, LONGMIRE Jr W . Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet. 1978; 146(6):959-62. View

Naritomi G, Tanaka M, Matsunaga H, Yokohata K, Ogawa Y, Chijiiwa K . Pancreatic head resection with and without preservation of the duodenum: different postoperative gastric motility. Surgery. 1996; 120(5):831-7. DOI: 10.1016/s0039-6060(96)80091-2. View

VANTRAPPEN G, Janssens J, Peeters T, Bloom S, Christofides N, Hellemans J . Motilin and the interdigestive migrating motor complex in man. Dig Dis Sci. 1979; 24(7):497-500. DOI: 10.1007/BF01489315. View

Peeters T, VANTRAPPEN G, Janssens J . Fasting plasma motilin levels are related to the interdigestive motility complex. Gastroenterology. 1980; 79(4):716-9. View

Traverso L, LONGMIRE Jr W . Preservation of the pylorus in pancreaticoduodenectomy a follow-up evaluation. Ann Surg. 1980; 192(3):306-10. PMC: 1344905. DOI: 10.1097/00000658-198009000-00005. View

Sarna S, Chey W, Condon R, Dodds W, Myers T, Chang T . Cause-and-effect relationship between motilin and migrating myoelectric complexes. Am J Physiol. 1983; 245(2):G277-84. DOI: 10.1152/ajpgi.1983.245.2.G277. View

BRAASCH J, Gongliang J, Rossi R . Pancreatoduodenectomy with preservation of the pylorus. World J Surg. 1984; 8(6):900-5. DOI: 10.1007/BF01656031. View

BRAASCH J, Deziel D, Rossi R, WATKINS Jr E, Winter P . Pyloric and gastric preserving pancreatic resection. Experience with 87 patients. Ann Surg. 1986; 204(4):411-8. PMC: 1251310. DOI: 10.1097/00000658-198610000-00009. View

Itani K, Coleman R, Meyers W, Akwari O . Pylorus-preserving pancreatoduodenectomy. A clinical and physiologic appraisal. Ann Surg. 1986; 204(6):655-64. PMC: 1251421. DOI: 10.1097/00000658-198612000-00007. View

10.

Szurszewski J . A migrating electric complex of canine small intestine. Am J Physiol. 1969; 217(6):1757-63. DOI: 10.1152/ajplegacy.1969.217.6.1757. View

11.

Brown J, COOK M, Dryburgh J . Motilin, a gastric motor activity-stimulating polypeptide: final purification, amino acid composition, and C-terminal residues. Gastroenterology. 1972; 62(3):401-4. View

12.

Polak J, Pearse A, Heath C . Complete identification of endocrine cells in the gastrointestinal tract using semithin-thin sections to identify motilin cells in human and animal intestine. Gut. 1975; 16(3):225-9. PMC: 1410960. DOI: 10.1136/gut.16.3.225. View

13.

Wingate D, Ruppin H, Green W, Thompson H, Domschke W, Wunsch E . Motilin-induced electrical activity in the canine gastrointestinal tract. Scand J Gastroenterol Suppl. 1976; 39:111-8. View

14.

Patti M, Pellegrini C, Way L . Gastric emptying and small bowel transit of solid food after pylorus-preserving pancreaticoduodenectomy. Arch Surg. 1987; 122(5):528-32. DOI: 10.1001/archsurg.1987.01400170034004. View

15.

Tanaka M, Sarr M . Total duodenectomy: effect on canine gastrointestinal motility. J Surg Res. 1987; 42(5):483-93. DOI: 10.1016/0022-4804(87)90022-9. View

16.

Tanaka M, Sarr M . Role of the duodenum in the control of canine gastrointestinal motility. Gastroenterology. 1988; 94(3):622-9. DOI: 10.1016/0016-5085(88)90232-6. View

17.

Tanaka M, Sarr M . Effects of exogenous motilin and morphine on interdigestive gastrointestinal motor activity after total duodenectomy in dogs. Surgery. 1988; 104(2):317-25. View

18.

Peeters T, Bormans V, VANTRAPPEN G . Comparison of motilin binding to crude homogenates of human and canine gastrointestinal smooth muscle tissue. Regul Pept. 1988; 23(2):171-82. DOI: 10.1016/0167-0115(88)90025-0. View

19.

Hunt D, McLean R . Pylorus-preserving pancreatectomy: functional results. Br J Surg. 1989; 76(2):173-6. DOI: 10.1002/bjs.1800760223. View

20.

Hocking M, Harrison W, Sninsky C . Gastric dysrhythmias following pylorus-preserving pancreaticoduodenectomy. Possible mechanism for early delayed gastric emptying. Dig Dis Sci. 1990; 35(10):1226-30. DOI: 10.1007/BF01536411. View