Gut hormones profile after an Ivor Lewis gastro-esophagectomy and its relationship to delayed gastric emptying.

Autor: Tham JC; Peninsula Oesophago-Gastric Centre, University Hospital Plymouth, Plymouth, UK., Pournaras DJ; Department of Upper Gastrointestinal Surgery, North Bristol NHS Trust, Bristol, UK., Alcocer B; Peninsula Oesophago-Gastric Centre, University Hospital Plymouth, Plymouth, UK., Forbes R; Peninsula Oesophago-Gastric Centre, University Hospital Plymouth, Plymouth, UK., Ariyarathenam AV; Peninsula Oesophago-Gastric Centre, University Hospital Plymouth, Plymouth, UK., Humphreys ML; Peninsula Oesophago-Gastric Centre, University Hospital Plymouth, Plymouth, UK., Berrisford RG; Peninsula Oesophago-Gastric Centre, University Hospital Plymouth, Plymouth, UK., Wheatley TJ; Peninsula Oesophago-Gastric Centre, University Hospital Plymouth, Plymouth, UK., Chan D; Peninsula Oesophago-Gastric Centre, University Hospital Plymouth, Plymouth, UK., Sanders G; Peninsula Oesophago-Gastric Centre, University Hospital Plymouth, Plymouth, UK., Lewis SJ; Department of Gastroenterology, University Hospital Plymouth, Plymouth, UK.
Jazyk: angličtina
Zdroj: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus [Dis Esophagus] 2022 Oct 14; Vol. 35 (10).
DOI: 10.1093/dote/doac008
Abstrakt: Delayed gastric emptying (DGE) is common after an Ivor Lewis gastro-esophagectomy (ILGO). The risk of a dilated conduit is the much-feared anastomotic leak. Therefore, prompt management of DGE is required. However, the pathophysiology of DGE is unclear. We proposed that post-ILGO patients with/without DGE have different gut hormone profiles (GHP). Consecutive patients undergoing an ILGO from 1 December 2017 to 31 November 2019 were recruited. Blood sampling was conducted on either day 4, 5, or 6 with baseline sample taken prior to a 193-kcal meal and after every 30 minutes for 2 hours. If patients received pyloric dilatation, a repeat profile was performed post-dilatation and were designated as had DGE. Analyses were conducted on the following groups: patient without dilatation (non-dilated) versus dilatation (dilated); and pre-dilatation versus post-dilatation. Gut hormone profiles analyzed were glucagon-like peptide-1 (GLP-1) and peptide tyrosine tyrosine (PYY) using radioimmunoassay. Of 65 patients, 24 (36.9%) had dilatation and 41 (63.1%) did not. For the non-dilated and dilated groups, there were no differences in day 4, 5, or 6 GLP-1 (P = 0.499) (95% confidence interval for non-dilated [2822.64, 4416.40] and dilated [2519.91, 3162.32]). However, PYY levels were raised in the non-dilated group (P = 0.021) (95% confidence interval for non-dilated [1620.38, 3005.75] and dilated [821.53, 1606.18]). Additionally, after pyloric dilatation, paired analysis showed no differences in GLP-1, but PYY levels were different at all time points and had an exaggerated post-prandial response. We conclude that DGE is associated with an obtunded PYY response. However, the exact nature of the association is not yet established.
(© The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze: MEDLINE
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