Retained antral mucosa in pancreaticoduodenectomy patients

Thirteen patients who had undergone pancreaticoduodenectomy (PD) were studied. Three patients presented with symptoms compatible with a stomal ulcer, in particular upper gastrointestinal bleeding. "Peptic disease" was diagnosed by endoscopy in these three patients (1 had stomal ulcer and 2 had bleeding stomitis). Endoscopic biopsies showed the presence of retained antral mucosa (RAM). No evidence of disease or RAM was found in the remaining ten patients. Basal gastric acid secretion and basal serum gastrin levels did not differ significantly in the two groups of patients. Bombesin (BBS) infusion effected a significant change in gastric acid and gastrin secretion only in the group of patients with RAM. We conclude that stomal ulcer is a relevant clinical problem in pd patients, RAM may be a crucial factor in the genesis of stomal ulcer, and the "BBS infusion test" is useful in detecting "high risk stomal ulcer" PD patients. © 1977.