technetium-tc-99m-lidofenin and Duodenal-Ulcer

It has been shown that truncal vagotomy with pyloroplasty (TVP), but not highly selective vagotomy (HSV), delays the onset, decreases the extent, and changes the pattern of gallbladder emptying. The aim of the present study was to investigate any alterations in gallbladder emptying after a variety of antiulcer gastric surgery, by milk-technetium 99m (99mTc)-dimethyl iminodiacetic acid (HIDA) scintigraphy. After excluding the cases with spontaneous gallbladder evacuation before milk ingestion, there were 26 controls, 41 duodenal ulcer (DU) patients, 22 after HSV (15 prospective cases), 50 after TVP (23 prospective cases), 8 after TV with gastrojejunostomy (TV-GJ), 10 after Billroth I gastrectomy, and 29 after Billroth II gastrectomy. None of the patients with gastrectomy had additional vagotomy. TVP significantly delayed the onset and decreased the rate of gallbladder emptying as compared with the control, DU, HSV, and Billroth I groups. TVP also changed the pattern of emptying in 20% of the cases (sequential emptying and refilling events). Antiulcer operations excluding the duodenum (TV-GJ and Billroth II) further reduced the rate of gallbladder emptying as compared with (1) control, DU, HSV, and Billroth I groups (P < 0.0001) and (2) TVP (P < 0.001). Onset of gallbladder emptying was not affected by Billroth II gastrectomy, but was significantly delayed by TV-GJ (P < 0.001). The latter two operations also significantly changed the pattern of gallbladder emptying, exhibiting sequential emptying and refilling events, in most cases (P < 0.01 versus TVP). In conclusion, all antiulcer procedures, except HSV, greatly disturb the pattern, the onset, and the rate of gallbladder emptying. Truncal vagotomy seems to disrupt vagally mediated preduodenal mechanism, resulting in delayed onset and reduced rate, whereas duodenal exclusion by gastrojejunostomy results in severely decreased rate of gallbladder emptying.

Topics: Duodenal Ulcer; Female; Gallbladder; Gallbladder Emptying; Gastrectomy; Gastrostomy; Humans; Imino Acids; Injections, Intravenous; Jejunostomy; Male; Organotechnetium Compounds; Postoperative Care; Postoperative Period; Prospective Studies; Pylorus; Radionuclide Imaging; Stomach Ulcer; Technetium Tc 99m Lidofenin; Time Factors; Vagotomy, Proximal Gastric; Vagotomy, Truncal

In 28 controls and 142 patients subjected to a variety of antiulcer procedures, the enterogastric reflux (EGR) was quantitated by 99mTc-HIDA scintigraphy and expressed as the EGR index on 229 different occasions. The EGR index was calculated according to two different formulas: one based on the maximal radioactivity over the gastric area as a percentage value of the total abdominal activity (EGR-Im) and the other based on the relative maximal radioactivity over the gastric area as a percentage value of the relative hepatobiliary activity (EGR-It). There was a significant positive correlation of values between the two methods (P less than 0.0001). In patients with an EGR-Im greater than 20% or EGR-It greater than 57% and postgastric surgery symptoms some of the symptoms were attributed to EGR, an antireflux procedure is expected to relieve those symptoms. Sixteen of these patients underwent Roux-en-Y gastrectomy and their preoperative symptoms were relieved.

Topics: Duodenal Ulcer; Duodenogastric Reflux; Female; Gastritis; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Postgastrectomy Syndromes; Radionuclide Imaging; Stomach; Technetium Tc 99m Lidofenin; Vagotomy, Proximal Gastric; Vagotomy, Truncal

Duodenogastric reflux was studied in 48 duodenal ulcer patients before and after medical (n = 8) or surgical therapy with either combined truncal vagotomy and gastrojejunostomy (n = 13) or pyloroplasty (n = 12), Polya partial gastrectomy (n = 8), or highly selective vagotomy (n = 7). Seven healthy subjects served as controls. The reflux was assessed both by using 99mTc diethyliminodiacetic acid (HIDA) scintigraphy and by measuring intragastric bile acid levels following endoscopic gastric juice aspiration. Before therapy, duodenal ulcer patients had significantly higher intragastric bile acid concentrations than did normal subjects (p less than 0.001). After truncal vagotomy and drainage, or partial gastrectomy, bile acid levels increased significantly, whereas they remained unchanged after medical therapy. Conversely, they were found to be significantly decreased after highly selective vagotomy. The results of HIDA scan measurements were compatible with those of gastric juice bile acids. We conclude that surgical treatment for duodenal ulcer by highly selective vagotomy is the only form of therapy, among the types considered, that leads to a reduction in duodenogastric reflux. It is of interest that medical therapy of the duodenal ulcer does not improve abnormal duodenogastric reflux, possibly contributing to both the failure of the medical treatment and recurrence of the ulcer.

Topics: Bile Acids and Salts; Duodenal Ulcer; Duodenogastric Reflux; Duodenoscopy; Gastrectomy; Gastric Juice; Gastrostomy; Histamine H2 Antagonists; Humans; Imino Acids; Jejunostomy; Organotechnetium Compounds; Prospective Studies; Pylorus; Radionuclide Imaging; Technetium Tc 99m Lidofenin; Vagotomy

Topics: Duodenal Ulcer; Duodenogastric Reflux; Humans; Imino Acids; Organometallic Compounds; Radionuclide Imaging; Stomach Ulcer; Technetium Tc 99m Lidofenin

The gastric emptying of a liquid meal (10% dextrose solution) and a semi-solid meal (minced meat, peas, potatoes and milk) was measured in the sitting position; both meals were 400 ml. Duodenogastric reflux was assessed supine after intravenous injection of 75 MBq of 99 mTc HIDA and cholecystokinin. Patients were ajudged reflux positive (R+), or reflux negative (R-) by looking at gamma camera pictures. Thirty-two duodenal ulcer patients (DU), 22 patients after truncal vagotomy and pyloroplasty (TV+P) and 21 after proximal gastric vagotomy (PGV) were studied. In DU sufferers the mean volume of early liquid emptying in R+ patients (74 ml) was similar to R- patients (78 ml). After TV+P early liquid emptying was greatly increased (mean 176 ml) but no difference was found between R+ and R- patients. After PGV excessive early emptying was less common but emptying was significantly greater in R+ patients (R+ mean = 132 ml, SD = 48 n = 8; R- mean = 63 ml, SD = 21, N = 13: t = 4.2 p less than 0.001). There was no difference in solid meal emptying between R+ and R- patients in any group.

Topics: Cholecystokinin; Duodenal Ulcer; Duodenogastric Reflux; Gastric Emptying; Humans; Imino Acids; Posture; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Vagotomy

Topics: Bile Reflux; Biliary Tract Diseases; Duodenal Ulcer; Female; Humans; Imino Acids; Male; Technetium; Technetium Tc 99m Lidofenin