Clinical Role of Secretin loading Magnetic Resonance Cholangiopancreatography in the Patients undergoing Pancreatic Resection
Background: We determined factors contributing to increased signal intensity in the reconstructed jejunal loop in patients undergoing pancreatic resection, frequently observed on magnetic resonance cholangiopancreatography following intravenous injection of secretin (S/MRCP). We also evaluated the p...
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| Published in | Nippon Shokaki Geka Gakkai zasshi Vol. 35; no. 1; pp. 1 - 10 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
The Japanese Society of Gastroenterological Surgery
2002
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0386-9768 1348-9372 1348-9372 |
| DOI | 10.5833/jjgs.35.1 |
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| Abstract | Background: We determined factors contributing to increased signal intensity in the reconstructed jejunal loop in patients undergoing pancreatic resection, frequently observed on magnetic resonance cholangiopancreatography following intravenous injection of secretin (S/MRCP). We also evaluated the possible roles of S/MRCP in assessing the patency of pancreatojejunal anastomosis and the secretory function of the remnant pancreas.Methods: Subject were 44 patients undergoing several types of pancreatic resection. Baseline output and response to secretin of the remnant pancreas were measured after surgery. S/middot;MRCP and pancreatic function diagnostant (PFD) tests were conducted preoperatively, and in early and late periods after surgery.Results: Baseline pancreatic output was 1.2±0.7ml/10-min, and increased after secretin load to a maximum 9.0±6.6ml/10-min in 10 min. Signal intensity of the jejunal loop increased in 2 patients versus 40 patients (95%) during the early versus late postoperative periods. During the late period, PFD was significantly higher in patients with increased signal intensity than in those without. PFD correlated well with cumulative pancreatic output following secretin loading (r=0.820).Conclusion: A major factor responsible for increased signal intensity in S/MRCP of the jejunal loop was increased pancreatic output. The increase in signal intensity was a definitive sign of patent pancreatojejunal anastomosis. S/MRCP thus seems to have a potential for evaluating the secretory function of the remnant pancreas. |
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| AbstractList | Background: We determined factors contributing to increased signal intensity in the reconstructed jejunal loop in patients undergoing pancreatic resection, frequently observed on magnetic resonance cholangiopancreatography following intravenous injection of secretin (S/MRCP). We also evaluated the possible roles of S/MRCP in assessing the patency of pancreatojejunal anastomosis and the secretory function of the remnant pancreas.Methods: Subject were 44 patients undergoing several types of pancreatic resection. Baseline output and response to secretin of the remnant pancreas were measured after surgery. S/middot;MRCP and pancreatic function diagnostant (PFD) tests were conducted preoperatively, and in early and late periods after surgery.Results: Baseline pancreatic output was 1.2±0.7ml/10-min, and increased after secretin load to a maximum 9.0±6.6ml/10-min in 10 min. Signal intensity of the jejunal loop increased in 2 patients versus 40 patients (95%) during the early versus late postoperative periods. During the late period, PFD was significantly higher in patients with increased signal intensity than in those without. PFD correlated well with cumulative pancreatic output following secretin loading (r=0.820).Conclusion: A major factor responsible for increased signal intensity in S/MRCP of the jejunal loop was increased pancreatic output. The increase in signal intensity was a definitive sign of patent pancreatojejunal anastomosis. S/MRCP thus seems to have a potential for evaluating the secretory function of the remnant pancreas. |
| Author | Takahashi, Tsuyoshi Kakita, Akira Simada, Ken Yoshida, Muneki |
| Author_xml | – sequence: 1 fullname: Takahashi, Tsuyoshi organization: Depertment of Surgery, Kitasato University School of Medicine – sequence: 1 fullname: Kakita, Akira organization: Depertment of Surgery, Kitasato University School of Medicine – sequence: 1 fullname: Simada, Ken organization: Depertment of Surgery, Kitasato University School of Medicine – sequence: 1 fullname: Yoshida, Muneki organization: Depertment of Surgery, Kitasato University School of Medicine |
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| Cites_doi | 10.2214/ajr.171.1.9648782 10.1148/radiology.199.1.8633178 10.1111/j.1600-0676.1998.tb00122.x 10.1152/ajplegacy.1937.121.1.270 10.1148/radiology.181.3.1947101 10.1016/S0016-5085(99)70567-6 10.1152/ajplegacy.1974.227.2.487 10.1007/BF00311562 10.1016/0003-9861(88)90376-1 10.1148/radiology.208.1.9646818 10.1148/radiology.192.1.8208969 10.1016/S0016-5085(69)80069-7 10.1148/radiology.203.2.9114101 10.1113/jphysiol.1902.sp000920 10.1016/S0016-5085(69)80006-5 10.1148/radiology.199.1.8633179 10.1172/JCI116705 10.1148/radiology.196.2.7617861 10.1042/cs0620557 10.2214/ajr.165.2.7618543 10.1172/JCI119655 10.1056/NEJM199907223410407 |
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| References | 20) Isenberg JI, Grossman MI: Comparison of subcutaneous and intravenous secretin in man. Gastroenterology 56: 88-91, 1969 21) Tauturi CA, Ivy AC: On the existence of secretary nerves in the vagi for and the reflex excitation and inhibitation of bile secretion. Am J Physiol 121: 270-283, 1938 27) 佐々木誠, 古川正人, 千葉憲哉: セクレチン負荷MRCPによる膵切除後残膵機能評価の試み-膵頭十二指腸切除長期生存2症例の検討-. 膵臓12: 301-309, 1997 28) Sterchi EE, Green JR, Lentze MJ: Non pancreatic hydrolysis of N-Benzoyl-L-tyrosyl-p-aminobenzoic acid (PABA-peptide) in human small intestine. Clin Sci 62: 577-560, 1982 15) Bayliss WM, Starling EH: The mechanism of pancreatic secretion. J Physiol 28: 325-353, 1902 16) Alvaro D, Cho WK, Mennone A et al: Effective of secretin on intracellular pH regulation in isolated rat bile duct epithelial cells. J Clin Investi 92: 1314-1325, 1993 4) Matos C, Metens T, Deviere J et al: Pancreatic duct: Morphologic and functional evaluation with dynamic MR pancreastography after secretin stimulation. Radiology 203: 435-441, 1997 9) Barish MA, Yucel EK, Ferrucci JT: Magnetic resonance cholangiopancreatography. New Engl J Med 341: 258-264, 1999 24) LeSage G, Alvaro D, Benedetti A et al: Cholinergic system modulates growth, apoptosis, and secretion of cholangiocytes from bile duct-ligated rats. Gastroenterology 117: 191-199, 1999 29) Sterchi EE, Naim HY, Lentze MJ et al: NBenzoyl-L-tyrosyl-p-aminobenzoic acid hydrolase: A metalloendopeptidase of the human intestinal microvillus membrane which degrades biologically active peptides. Arch Biochem Biophys265: 105-118, 1988 12) 北村雅也, 高橋毅, 吉田宗紀ほか: 膵管形態および膵管口の開存評価法としてのmagnetic resonance cholangiopancreatography (MRCP)の有用性. 日臨外会誌60: 344-350, 1999 13) 島田謙, 高橋毅, 中村考伸ほか: 膵頭十二指腸切除後のMRCPと膵外分泌能-セクレチン負荷MRCPは膵外分泌能を反映するか-. 胆膵の生理機能15: 31-34, 1999 3) Barish MA, Yucel EK, Sota JA et al: MR cholangiopancreatography: effcacy of three-dimensional turbo spin-echo technique. Am J Roentogenol 165: 295-300, 1995 25) 田所文彦: 切断後の肝臓神経の再生に関する免疫組織学的研究. 肝臓35: 29-37, 1994 31) 久永倫聖, 中島祥介, 症雅之ほか: セクレチン負荷MRCPによる膵頭十二指腸切除術後の残膵生理機能評価.胆膵の生理機能15: 35-38, 1999 1) Takehara Y, Ichijo K, Tooyama N et al: Breathhold MR cholangiopancreatography with a lomgecho-train fast spin-echo sequence and a surfacee coil in chronic pancreastitis. Radiology 192: 73-78, 1994 6) Brest PM, Reinhold C, Taourel P et al: Pancreas divism: evaluation with MR cholangiopamcreatography. Radiology 199: 99-103, 1996 2) Sota JA, Barisjh MA, Yucel EK et al: Pancreatic duct: MR cholangiopancreatography with a three-dimensional fast spin-echo technique. Radiology 196: 459-464, 1995 5) Sota J, Yucel EK, Barish MA et al: MR cholangiopancreatography after unsuccessfull or incomplete ERCP. Radiology 199: 91-98, 1996 22) Kaminski DL, Dorighi J, Jellinek M: Effect of electrical vagal stimulation on canine hepatic bile flow. Am J Physiol 227: 487-493, 1994 11) 森本耕治, 青木圭子, 崔秀美ほか: MR chorangiography. 日医放線会誌51: 833-835, 1991 17) Stenig GF, Grossman MI: Hormonal control of Brunner's Gland. Gastroenterology 56: 1047-1052, 1969 18) Kakita A, Takahashi T, Yoshida M et al: A simpler and more reliable technique of pancreatojejunal anastomosis. Jpn J Surg 26: 532-535, 1996 19) 江本節, 中尾量保, 藤田修弘ほか: 膵頭十二指腸切除後における膵外分泌機能の検討. 胆膵の生理機能11: 53-56, 1995 23) Alvaro D, Alpini G, Jezequel AM et al: Role and mechanisms of acethylcholine in the regulation of cholangiocystes secretary function. J Clin Invest 100: 1349-1362, 1997 14) 島田謙, 高橋毅, 磯部義憲ほか: 膵外分泌能とMRCP画像についての検討. 胆膵の生理機能16: 23-26, 2000 8) Koito K, Namieno T, Ichimura T et al: Mucin producing pancreastic tumors: comparison of MR cholangiopancreatography with endoscopic retrograde cholangiopancreatography. Radiology 1998: 231-237, 1998 10) Wallner BK, Schmacher KA, Weidenmaier W et al: Dilated biliary tract: evaluation with MR cholangiography with a T2-weighted contrast-enhanced fast sequence. Radiology 181: 805-808, 1991 7) Onaya H, Itai Y, Niitu M et al: Ductectatic mucinous cystic neoplasms of the pancreas: evaluation with MR cholangiopancreatography. Am J Roentogenol 171: 171-177, 1998 30) 仙波大石, 石原敬夫, 森岡恭彦: 膵外分泌機能検査法BT-PABA test (PFD)に関する検討. 日消病会誌91: 1956-1962, 1994 26) Ito Y, Takahashi T, Tadokoro F et al: Regeneration of the hepatic nerves following surgical denervation of the liver in dogs. Liver 18: 20-26, 1998 22 23 24 25 26 27 28 29 30 31 10 11 12 13 14 15 16 17 18 19 1 2 3 4 5 6 7 8 9 20 21 |
| References_xml | – reference: 6) Brest PM, Reinhold C, Taourel P et al: Pancreas divism: evaluation with MR cholangiopamcreatography. Radiology 199: 99-103, 1996 – reference: 19) 江本節, 中尾量保, 藤田修弘ほか: 膵頭十二指腸切除後における膵外分泌機能の検討. 胆膵の生理機能11: 53-56, 1995 – reference: 22) Kaminski DL, Dorighi J, Jellinek M: Effect of electrical vagal stimulation on canine hepatic bile flow. Am J Physiol 227: 487-493, 1994 – reference: 27) 佐々木誠, 古川正人, 千葉憲哉: セクレチン負荷MRCPによる膵切除後残膵機能評価の試み-膵頭十二指腸切除長期生存2症例の検討-. 膵臓12: 301-309, 1997 – reference: 24) LeSage G, Alvaro D, Benedetti A et al: Cholinergic system modulates growth, apoptosis, and secretion of cholangiocytes from bile duct-ligated rats. Gastroenterology 117: 191-199, 1999 – reference: 25) 田所文彦: 切断後の肝臓神経の再生に関する免疫組織学的研究. 肝臓35: 29-37, 1994 – reference: 17) Stenig GF, Grossman MI: Hormonal control of Brunner's Gland. Gastroenterology 56: 1047-1052, 1969 – reference: 18) Kakita A, Takahashi T, Yoshida M et al: A simpler and more reliable technique of pancreatojejunal anastomosis. Jpn J Surg 26: 532-535, 1996 – reference: 16) Alvaro D, Cho WK, Mennone A et al: Effective of secretin on intracellular pH regulation in isolated rat bile duct epithelial cells. J Clin Investi 92: 1314-1325, 1993 – reference: 8) Koito K, Namieno T, Ichimura T et al: Mucin producing pancreastic tumors: comparison of MR cholangiopancreatography with endoscopic retrograde cholangiopancreatography. Radiology 1998: 231-237, 1998 – reference: 11) 森本耕治, 青木圭子, 崔秀美ほか: MR chorangiography. 日医放線会誌51: 833-835, 1991 – reference: 23) Alvaro D, Alpini G, Jezequel AM et al: Role and mechanisms of acethylcholine in the regulation of cholangiocystes secretary function. J Clin Invest 100: 1349-1362, 1997 – reference: 31) 久永倫聖, 中島祥介, 症雅之ほか: セクレチン負荷MRCPによる膵頭十二指腸切除術後の残膵生理機能評価.胆膵の生理機能15: 35-38, 1999 – reference: 3) Barish MA, Yucel EK, Sota JA et al: MR cholangiopancreatography: effcacy of three-dimensional turbo spin-echo technique. Am J Roentogenol 165: 295-300, 1995 – reference: 7) Onaya H, Itai Y, Niitu M et al: Ductectatic mucinous cystic neoplasms of the pancreas: evaluation with MR cholangiopancreatography. Am J Roentogenol 171: 171-177, 1998 – reference: 4) Matos C, Metens T, Deviere J et al: Pancreatic duct: Morphologic and functional evaluation with dynamic MR pancreastography after secretin stimulation. Radiology 203: 435-441, 1997 – reference: 13) 島田謙, 高橋毅, 中村考伸ほか: 膵頭十二指腸切除後のMRCPと膵外分泌能-セクレチン負荷MRCPは膵外分泌能を反映するか-. 胆膵の生理機能15: 31-34, 1999 – reference: 2) Sota JA, Barisjh MA, Yucel EK et al: Pancreatic duct: MR cholangiopancreatography with a three-dimensional fast spin-echo technique. Radiology 196: 459-464, 1995 – reference: 28) Sterchi EE, Green JR, Lentze MJ: Non pancreatic hydrolysis of N-Benzoyl-L-tyrosyl-p-aminobenzoic acid (PABA-peptide) in human small intestine. Clin Sci 62: 577-560, 1982 – reference: 30) 仙波大石, 石原敬夫, 森岡恭彦: 膵外分泌機能検査法BT-PABA test (PFD)に関する検討. 日消病会誌91: 1956-1962, 1994 – reference: 29) Sterchi EE, Naim HY, Lentze MJ et al: NBenzoyl-L-tyrosyl-p-aminobenzoic acid hydrolase: A metalloendopeptidase of the human intestinal microvillus membrane which degrades biologically active peptides. Arch Biochem Biophys265: 105-118, 1988 – reference: 14) 島田謙, 高橋毅, 磯部義憲ほか: 膵外分泌能とMRCP画像についての検討. 胆膵の生理機能16: 23-26, 2000 – reference: 15) Bayliss WM, Starling EH: The mechanism of pancreatic secretion. J Physiol 28: 325-353, 1902 – reference: 20) Isenberg JI, Grossman MI: Comparison of subcutaneous and intravenous secretin in man. Gastroenterology 56: 88-91, 1969 – reference: 5) Sota J, Yucel EK, Barish MA et al: MR cholangiopancreatography after unsuccessfull or incomplete ERCP. Radiology 199: 91-98, 1996 – reference: 10) Wallner BK, Schmacher KA, Weidenmaier W et al: Dilated biliary tract: evaluation with MR cholangiography with a T2-weighted contrast-enhanced fast sequence. Radiology 181: 805-808, 1991 – reference: 12) 北村雅也, 高橋毅, 吉田宗紀ほか: 膵管形態および膵管口の開存評価法としてのmagnetic resonance cholangiopancreatography (MRCP)の有用性. 日臨外会誌60: 344-350, 1999 – reference: 1) Takehara Y, Ichijo K, Tooyama N et al: Breathhold MR cholangiopancreatography with a lomgecho-train fast spin-echo sequence and a surfacee coil in chronic pancreastitis. Radiology 192: 73-78, 1994 – reference: 26) Ito Y, Takahashi T, Tadokoro F et al: Regeneration of the hepatic nerves following surgical denervation of the liver in dogs. Liver 18: 20-26, 1998 – reference: 9) Barish MA, Yucel EK, Ferrucci JT: Magnetic resonance cholangiopancreatography. New Engl J Med 341: 258-264, 1999 – reference: 21) Tauturi CA, Ivy AC: On the existence of secretary nerves in the vagi for and the reflex excitation and inhibitation of bile secretion. Am J Physiol 121: 270-283, 1938 – ident: 7 doi: 10.2214/ajr.171.1.9648782 – ident: 12 – ident: 5 doi: 10.1148/radiology.199.1.8633178 – ident: 26 doi: 10.1111/j.1600-0676.1998.tb00122.x – ident: 14 – ident: 31 – ident: 21 doi: 10.1152/ajplegacy.1937.121.1.270 – ident: 10 doi: 10.1148/radiology.181.3.1947101 – ident: 24 doi: 10.1016/S0016-5085(99)70567-6 – ident: 22 doi: 10.1152/ajplegacy.1974.227.2.487 – ident: 18 doi: 10.1007/BF00311562 – ident: 29 doi: 10.1016/0003-9861(88)90376-1 – ident: 8 doi: 10.1148/radiology.208.1.9646818 – ident: 1 doi: 10.1148/radiology.192.1.8208969 – ident: 20 doi: 10.1016/S0016-5085(69)80069-7 – ident: 11 – ident: 4 doi: 10.1148/radiology.203.2.9114101 – ident: 15 doi: 10.1113/jphysiol.1902.sp000920 – ident: 17 doi: 10.1016/S0016-5085(69)80006-5 – ident: 19 – ident: 13 – ident: 6 doi: 10.1148/radiology.199.1.8633179 – ident: 30 – ident: 16 doi: 10.1172/JCI116705 – ident: 2 doi: 10.1148/radiology.196.2.7617861 – ident: 28 doi: 10.1042/cs0620557 – ident: 3 doi: 10.2214/ajr.165.2.7618543 – ident: 23 doi: 10.1172/JCI119655 – ident: 9 doi: 10.1056/NEJM199907223410407 – ident: 27 – ident: 25 |
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| Title | Clinical Role of Secretin loading Magnetic Resonance Cholangiopancreatography in the Patients undergoing Pancreatic Resection |
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