J.Jpn. Surg. Soc.. 82(2): 162-168, 1981

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Original article

CLINICAL STUDY OF PANCREATIC ENDOCRINE FUNCTION AFTER TOTAL GASTRECTOMY

This clinical investigation evaluates the effects of total gastrectomy and esophagectomy on plasma glucagon, plasma insulin and blood glucose in three groups of patients (Roux en Y reconstruction,interposition reconstruction after total gastrectomy and intrathoracic stomach replacement after esophagectomy)after oral glucose and intravenous glucose loads, about one month after surgery.
In patients with total gastrectomy, plasma glucagon was decreased by intravenous glucose load but was increased by oral glucose load. After Roux en Y reconstruction, the plasma glucagon response to oral glucose was higher than after interposition reconstruction. In patients with esophagectomy, plasma glucagon was increased after oral glucose load. Because truncal vagotomy is carried out in total gastrectomy and in esophagectomy, we conclude that these operations result hyperglucagonemia based on a defect of vagal inhibition of glucagon release. The plasma insulin response to oral glucose load after interposition reconstruction was higher than after Roux en Y reconstruction. Blood glucose levels after oral glucose load changed from a normoglycemic to a hyperglycemic pattern after surgery. These results suggest that hyperglycemia may be due to hyperglucagonemia after gastric surgery.

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