Br. J. Surg. Vol. 66 (1979) 149-151
Interrelations between serum gastrin levels, gastric emptying and acid output before and after proximal gastric vagotomy and truncal vagotomy and antrectomy I. A. D O N O V A N , C A R O L I N E OWENS, B. G. C L E N D I N N E N , D. W. G R I F F I N , L. K. H A R D I N G A N D J. A L E X A N D E R - W I L L I A M S * SUMMARY
Zn a prospective study of proximal gastric vagotomy and truncul vagotomy and antrectomy measurements were made, before and after operation, of acid output, gastrin output and gustric emptying of a solid and a liquid meat extract meal. No relationships were demonstrable between acid output and gastrin output. Truncal vagotomy and antrectomy (TVA) produced rapid early emptying of both meals combined with gross prolongation of the overall emptying of the solid meal. Truncal vugotomy and antrectomy reduced the integrated gastrin output after either meal. Proximal gastric vagotomy ( P C V ) produced rapid early emptying of the liquid meal with no alteration in the eariy emptying of the solid meal; however, overall solid meal emptying was delayed. Proximal gastric vagotomy increased basal, peak and integrated gastrin output. Zn preoperative patients slow solid meal emptying was associated with higher gastrin output but after PGV the reverse was found, the slowest emptiers having the lowest gastrin output. These findings do not support the contention that a pyloroplasty should be added to PC V to reduce the hypergastrinaemia produced by the operation.
HOLLE(1974) has stated that proximal gastric vagotomy (PGV) requires the addition of a pyloroplasty in order to rectify the delay produced in the gastric emptying of solid food. The rationale is that higher than normal gastrin levels seen after PGV as opposed to after PGV and pyloroplasty (Jaffe et al., 1974) are due to delayed antral emptying and may stimulate acid output and predispose to recurrent ulceration. To assess the validity of this hypothesis we have measured the relevant physiological indices in a prospective trial of PGV and truncal vagotomy and antrectomy (TVA) in the treatment of duodenal ulcerat ion. Patients and methods Twenty-one male patients with radiologically proved duodenal ulceration were randomly allocated for either PGV o r TVA with a gastroduodenal anastomosis. Before and 3 months after operation the following studies were performed: 1. Basal acid output (BAO) and the peak acid output to pentagastrin 0.6 pg/kg PAO,,. 2. The gastric emptying of a liquid meal of 400 ml of meat extract solution (40 g meat extract), and of a mixed meal of 400 ml of minced meat, peas, potato and milk. Measurements were made with a n external scanning technique using a gamma camera and the meals were labelled with indium I 13m chelated with DTPA. The details of the method have been described elsewhere (Donovan, 1976). 3. Serum gastrin concentrations were measured by the radioimmunoassay method (Jackson et al., 1972) using an antibody which detects G34, GI7 and G13. Measurements were made in the fasting state and during the gastric emptying studies at 10, 20, 30, 40, 60 and 90 min after the start of the meal. The integrated gastrin output ([GO) was devised by calculating the area under the curve.
The statistical test used t o compare data was the nonparametric Mann-Whitney U test. Where correlations have been attempted, the non-parametric Spearman’s ranked correlation has been applied.
Results The restilts of the acid output studies are shown in Table Z. There was no significant difference in the reduction of basal acid output after TVA compared with PGV. However, after TVA the reduction in peak acid output was significantly greater than that seen after PGV (U = 2.6, P
Interrelations between serum gastrin levels, gastric emptying and acid output before and after proximal gastric vagotomy and truncal vagotomy and antrectomy I. A. D O N O V A N , C A R O L I N E OWENS, B. G. C L E N D I N N E N , D. W. G R I F F I N , L. K. H A R D I N G A N D J. A L E X A N D E R - W I L L I A M S * SUMMARY
Zn a prospective study of proximal gastric vagotomy and truncul vagotomy and antrectomy measurements were made, before and after operation, of acid output, gastrin output and gustric emptying of a solid and a liquid meat extract meal. No relationships were demonstrable between acid output and gastrin output. Truncal vagotomy and antrectomy (TVA) produced rapid early emptying of both meals combined with gross prolongation of the overall emptying of the solid meal. Truncal vugotomy and antrectomy reduced the integrated gastrin output after either meal. Proximal gastric vagotomy ( P C V ) produced rapid early emptying of the liquid meal with no alteration in the eariy emptying of the solid meal; however, overall solid meal emptying was delayed. Proximal gastric vagotomy increased basal, peak and integrated gastrin output. Zn preoperative patients slow solid meal emptying was associated with higher gastrin output but after PGV the reverse was found, the slowest emptiers having the lowest gastrin output. These findings do not support the contention that a pyloroplasty should be added to PC V to reduce the hypergastrinaemia produced by the operation.
HOLLE(1974) has stated that proximal gastric vagotomy (PGV) requires the addition of a pyloroplasty in order to rectify the delay produced in the gastric emptying of solid food. The rationale is that higher than normal gastrin levels seen after PGV as opposed to after PGV and pyloroplasty (Jaffe et al., 1974) are due to delayed antral emptying and may stimulate acid output and predispose to recurrent ulceration. To assess the validity of this hypothesis we have measured the relevant physiological indices in a prospective trial of PGV and truncal vagotomy and antrectomy (TVA) in the treatment of duodenal ulcerat ion. Patients and methods Twenty-one male patients with radiologically proved duodenal ulceration were randomly allocated for either PGV o r TVA with a gastroduodenal anastomosis. Before and 3 months after operation the following studies were performed: 1. Basal acid output (BAO) and the peak acid output to pentagastrin 0.6 pg/kg PAO,,. 2. The gastric emptying of a liquid meal of 400 ml of meat extract solution (40 g meat extract), and of a mixed meal of 400 ml of minced meat, peas, potato and milk. Measurements were made with a n external scanning technique using a gamma camera and the meals were labelled with indium I 13m chelated with DTPA. The details of the method have been described elsewhere (Donovan, 1976). 3. Serum gastrin concentrations were measured by the radioimmunoassay method (Jackson et al., 1972) using an antibody which detects G34, GI7 and G13. Measurements were made in the fasting state and during the gastric emptying studies at 10, 20, 30, 40, 60 and 90 min after the start of the meal. The integrated gastrin output ([GO) was devised by calculating the area under the curve.
The statistical test used t o compare data was the nonparametric Mann-Whitney U test. Where correlations have been attempted, the non-parametric Spearman’s ranked correlation has been applied.
Results The restilts of the acid output studies are shown in Table Z. There was no significant difference in the reduction of basal acid output after TVA compared with PGV. However, after TVA the reduction in peak acid output was significantly greater than that seen after PGV (U = 2.6, P
