Gastric pH and amylase and safety for non-stented pancreaticogastrostomy

The main purpose of this study was to try to provide the indirect evidence of protection against marginal ulceration by neutralizing the gastric acidity with alkaline pancreatic secretions following non-stented pancreaticogastrostomy after pylorus-preserving pancreaticoduodenectomy (PPPD-PG). Safety of the non-stented PPPD-PG was also evaluated and reviewed.

Twenty-five patients with resectable periampullary lesions undergoing non-stented PPPD-PG were recruited for study. Gastric pH and amylase levels were measured on postoperative day 7. Morbidity, pancreatic leakage and mortality were also evaluated.

The median values of gastric pH and amylase following non-stented PPPD-PG group were both statistically higher than those of healthy control group (pH, 6.3 vs. 2.8; amylase, 26,300 vs. 21 IU/L). The overall complication rate was 24.0%. Gastric atonia was the most common complication, occurring in 4 (16%) patients. No pancreatic leakage or ulcer-related complication such as upper gastrointestinal bleeding or perforation occurred in patients after non-stented PPPD-PG. There was 1 (4.0%) death, which was secondary to cardiac arrhythmia, but not related to operation.

Non-stented PPPD-PG could increase gastric pH and amylase levels, which might provide protection against marginal ulceration. No pancreatic leakage, and low morbidity and mortality confirm that non-stented PPPD-PG could be a relatively safe and reliable alternative in the pancreatic reconstruction after pancreaticoduodenecomy.