Pancreatic exocrine insufficiency post-gastrectomy, oesophagectomy and pancreatico-duodenectomy

2017-02-15T05:06:09Z (GMT) by Ward, Salena
Patients after the major upper gastrointestinal operations of gastrectomy, oesophagectomy and pancreatico-duodenectomy can have post-operative problems with malnutrition and weight loss. One contributing cause is postulated to be pancreatic exocrine insufficiency (PEl). There are several different tests which can be used to investigate pancreatic exocrine function, but each test has a practical disadvantage. One relatively new test of pancreatic exocrine function is the 6-hour Carbon 13 mixed triglyceride breath test (13C-MTG-BT), which is more convenient and acceptable to patients than some other tests. This research project aimed to use the 13C-MTG-BT to investigate pancreatic exocrine function in controls and post-operative patients in order to measure the incidence of PEl in patients after major upper gastrointestinal operations, and also to assess various clinical characteristics and correlate these with the 13C-MTG-BT results. Section 1 is the preface. Section 2 summarises the literature on pancreatic exocrine function tests, pancreatic exocrine function testing after gastrectomy, oesophagectomy and panrreatico-duodenectomy, and previous use of the 13C-MTG-BT. Section 3 describes the use of the 13C-MTG-BT in testing controls and post-operative patients. During the research and analysis of the 13C-MTG-BT results, it became apparent that there were two variables in test protocol which should be analysed further. Section 4 describes analysis of two variables in test protocol, which are reliability in sampling the initial breath only once, and variation in sampling the first and mid parts of the breath for each breath sample. Overall, the experimental program found a 15% incidence of PEl in the collective post-operative group of patients when assessed using the 13C-MTG-BT, although the difference between surgical cases and controls was not statistically significant. A larger study into post-operative pancreatic exocrine function is indicated. Analysis of the technique of breath sampling in the 13C-MTG-BT suggests that one baseline measurement can be highly variable and the mean of several measurements may be more accurate, and also that the part of the breath sampled is not particularly important but should be consistent. The test protocol needs further assessment to determine a more robust protocol before further investigations with the 13C-MTG-BT are performed.