Enhancing the Anti-Dumping Effect of Roux Gastrojejunostomy with Intestinal Pacing

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Abstract
We wondered whether Roux gastrojejunostomy alone or with intestinal pacing would slow gastric emptying and ameliorate the dumping syndrome after truncal vagotomy and subtotal distal gastrectomy. In five conscious dogs with vagotomy and distal gastrectomy, the Roux loop alone slowed gastric emptying of 100 ml 5% glucose instillates, but not of 100 ml 25% glucose instillates, while pacing the loop backwards slowed emptying of both. Pacing also decreased the postcibal hemoconcentration and hyperglycemia found after the 25% instillates. However, pacing did not alter the postprandial hyper-GIP-emia (gastric inhibitory peptide) and hyperinsulinemia found in Roux gastrectomy dogs, suggesting that pacing worked by slowing emptying of glucose rather than by releasing enteric hormones. Although pacing did not stimulate jejunal action potentials (contractions), the greater the number of action potentials occurring during pacing, the more the slowing (r = .738, p < .001). We concluded that the combination of Roux gastrojejunostomy and pacing ameliorated postgastrectomy dumping in dogs. The tests provide a basis for treating humans with postgastrectomy dumping.