[Pancreatic duct occlusion. Experimental studies and clinical application]

Area of Science:

• Gastroenterology
• Surgical Oncology
• Endocrinology

Background:

• Post-surgical complications, including pancreatic fistulas, can arise from persistent exocrine function after Whipple's procedure or pancreatic transplantation.
• Pancreatic duct occlusion with prolamin (Ethibloc) has been explored since 1978 as a method to mitigate exocrine function.
• Evaluating the endocrinological and morphological effects of pancreatic duct occlusion is crucial for surgical outcomes.

Purpose of the Study:

• To investigate the endocrinological and morphological consequences of pancreatic duct occlusion in piglets.
• To assess the safety and efficacy of combining Whipple's procedure with pancreatic duct occlusion in human patients.

Main Methods:

• Conducted experimental studies on 81 piglets involving pancreatic duct occlusion.
• Monitored serum amylase levels, fasting blood glucose, intravenous glucose tolerance, and insulin levels in piglets.
• Performed Whipple's procedures combined with pancreatic duct occlusion in seven human patients, with a 12-month follow-up.

Main Results:

• Piglets exhibited a transient rise in serum amylase post-occlusion, normalizing within 2-4 weeks.
• Piglets remained normoglycemic for up to one year, with normal glucose tolerance and insulin levels.
• All seven human patients survived the combined procedure without pancreatic fistulas; three patients demonstrated normoglycemia at 12 months postoperatively.

Conclusions:

• Pancreatic duct occlusion is a viable method for reducing exocrine function, potentially preventing complications after pancreatic surgery.
• The experimental and clinical data suggest that combining Whipple's procedure with pancreatic duct occlusion is safe and may improve glycemic control.
• Further research is warranted to fully elucidate the long-term benefits and optimal application of pancreatic duct occlusion in pancreatic surgery.