Plasma levels of glucagon-like polypeptides in gastrectomized patients transformed from Billroth II into Billroth I

Emptying of the gastric substitute after total gastrectomy. Jejunal interposition versus Roux-y esophagojejunostomy

Emptying of the gastric substitute and small bowel transit time of a 99mTc-labeled solid test meal were measured in 20 tumor-free patients 13 to 63 (median, 35) months after total gastrectomy with Roux-y (n = 11) and jejunal interposition (n = 9) reconstruction. The emptying half-times ranged from 2 minutes to greater than 20 minutes. Rapid emptying was associated with dumping symptoms (p less than 0.03) and shorter orocoecal transit-time (p less than 0.05). Serum glucose concentrations rose more quickly in jejunal interposition, but the areas under the curve were identical in both groups. The median insulin-to-glucose ratio (areas under the curve) during the 20 minutes after the meal was 11.4 in jejunal interposition and 7.1 in Roux-y esophagojejunostomy (NS). Interposition cases had regained a significantly higher percentage (89%) of their premorbid weight than patients with Roux-y (78%; p less than 0.05). The weight/height2 ratio was above the 50th centile in 45% of interpositions, but below the 50th centile in all patients after the Roux-y mode of reconstruction (p less than 0.05). It is concluded that the emptying velocity of the gastric substitute has no impact on postoperative weight gain. The authors contend that the concept of a gastric substitute pouch is not supported by the findings of this study.

Glucagon and insulin release in totally gastrectomized rats

In the fasting state, totally gastrectomized rats had higher glycemia, higher glucagonemia and lower insulinemia than normal rats. However, they are not prediabetic or diabetic, because after a glucose tolerance test the response of glucagon secretion, though accentuated at the beginning, decreased sharply when insulin secretion was stimulated. The evolution of glucagonemia and insulinemia indicated that the positive-negative feedback of the couple alpha-beta cells of islets of Langerhans still regulated glucose homeostasis. Hypoglycemia seen after the glucose test in operated rats disappeared when soluble starch replaced glucose. With soluble starch, hyperglycemia, hyperglucagonemia and hyperinsulinemia were less marked than with glucose at 30 min. Therefore, we conclude that 1) Gastrectomy, in removing the stomach with all its physiological role, has conferred to the operated rat in the fasting state a new level of hormonal glucose counterregulation close to the diabetic or prediabetic situation; but once the animal is fed, its endocrine pancreas responses quite normally, and 2) In the sugar tolerance test, soluble starch induces less release of glucagon and insulin than glucose.