Comparative effects of enteric-coated pancreatin microsphere therapy after conventional and pylorus-preserving pancreatoduodenectomy

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Abstract
Background A comparative study was performed between patients with exocrine pancreatic insufficiency after conventional pancreatoduodenectomy (Whipple′s procedure) and pylorus‐preserving pancreatoduodenectomy (PPPD). In these patients the pharmacodynamics of 2‐mm enteric‐coated pancreatin microspheres (ECPMs) and their gastric transit time in relation to that of a solid meal were investigated. The efficacy of ECPM preparations may differ after Whipple′s procedure compared with PPPD, because the latter procedure does not include gastrectomy. Methods Gastric transit was assessed by double‐isotope scintigraphy. A pancake meal was labelled with 99mTc. ECPMs were cold‐labelled with 170Er and neutron activated shortly before ingestion to enable imaging with a δ camera. Intraluminal pancreatic enzyme activity was assessed during a 6‐h period with two indirect tests: the cholesteryl [14C]octanoate breath test and the N‐benzoyl‐L‐tyrosyl‐p‐aminobenzoic acid‐p‐aminosalicylic acid (NBT‐PABA‐PAS) test. Results In patients who had Whipple's procedure, the gastric transit time of ECPMs and of the pancake meal was 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 greatly delayed compared with that of the pancake meal (PP < 0·05). Conclusion In cases of exocrine pancreatic insufficiency after Whipple's procedure, 2‐mm ECPM treatment adequately restores pancreatic enzyme activity. Following PPPD, however, ECPM treatment is often ineffective because the microspheres are retained in the stomach. In these patients, use of conventional powdered pancreatin enzyme preparations may improve the efficacy of treatment.
Funding Information
  • Knoll, Amsterdam, The Netherlands