PubMed · 261478
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J Girodet. 1979-12-20. [Gastric intubation and functional studies].. https://pubmed.ncbi.nlm.nih.gov/261478/
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An intraoperative test for the completeness of vagotomy has been evaluated in 103 consecutive operations, including proximal gastric, selective and truncal vagotomies, and truncal vagotomy with antrectomy. At the completion of the vagotomy a pH probe was used to test gastric mucosal response to an intravenous infusion of pentagastrin, aiming to detect undivided vagal fibres by localizing residual areas of acid secretion. Testing was performed in 86 out of 103 vagotomies, and in only 34% was the vagotomy judged complete at the first attempt. Residual areas of acid secretion (usually small) were detected in the remainder, and in early all of these it was possible to abolish these areas by dividing further vagal fibres. It is suggested that intraoperative pH testing improves the likelihood of a complete vagotomy. The test is also useful to plot precisely the antral-body junction when antrectomy is combined with vagotomy.
A single scan technique using 99mTc has been developed for the measurement of gastric acid output. After an overnight fast, pentagastrin (6 microgram/kg S.C.) was given 15 min before 99mTc (1 mCi i.v.), and a scan of the abdomen was performed 15 min later using a double-headed scanner. Accumulation of isotope within the stomach was then calculated from the scan and expressed as a percentage of the injected dose. Pentagastrin-stimulated intragastric activity correlated with acid output measured conventionally on a separate occasion (r = 0.87, P less than 0.0001). The test is rapidly performed with minimal inconvenience and discomfort to the patient, and the dose of irradiation used is small. The advantages of the method compared with intubation and gastric aspiration are discussed.
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