Endogenous glucagon-like peptide 1 controls endocrine pancreatic secretion and antro-pyloro-duodenal motility in humans.

BACKGROUND: Exogenous use of the intestinal hormone glucagon-like peptide 1 (GLP-1) lowers glycaemia by stimulation of insulin, inhibition of glucagon, and delay of gastric emptying. AIMS: To assess the effects of endogenous GLP-1 on endocrine pancreatic secretion and antro-pyloro-duodenal motility by utilising the GLP-1 receptor antagonist exendin(9-39)amide (ex(9-39)NH2). METHODS: Nine healthy volunteers underwent four experiments each. In two experiments with and without intravenous infusion of ex(9-39)NH2 300 pmol/kg/min, a fasting period was followed by intraduodenal glucose perfusion at 1 and 2.5 kcal/min, with the higher dose stimulating GLP-1 release. Antro-pyloro-duodenal motility was measured by perfusion manometry. To calculate the incretin effect (that is, the proportion of plasma insulin stimulated by intestinal hormones) the glycaemia observed during the luminal glucose experiments was mimicked using intravenous glucose in two further experiments. RESULTS: Ex(9-39)NH2 significantly increased glycaemia during fasting and duodenal glucose. It diminished plasma insulin during duodenal glucose and significantly reduced the incretin effect by approximately 50%. Ex(9-39)NH2 raised plasma glucagon during fasting and abolished the decrease in glucagon at the high duodenal glucose load. Ex(9-39)NH2 markedly stimulated antroduodenal contractility. At low duodenal glucose it reduced the stimulation of tonic and phasic pyloric motility. At the high duodenal glucose load it abolished pyloric stimulation. CONCLUSIONS: Endogenous GLP-1 stimulates postprandial insulin release. The pancreatic alpha cell is under the tonic inhibitory control of GLP-1 thereby suppressing postprandial glucagon. GLP-1 tonically inhibits antroduodenal motility and mediates the postprandial inhibition of antral and stimulation of pyloric motility. We therefore suggest GLP-1 as a true incretin hormone and enterogastrone in humans.

Modified percutaneous endoscopic gastrostomy (PEG) with gastropexy--early experience with a new introducer technique.

OBJECTIVE: The Cliny PEG 13 has been available since 1999 for clinical use in the modified introducer technique in combination with endoscopically controlled gastropexy. Data on indication, insertion technique and safety have not yet been reported in the literature. METHODS: During the time period from January 1999 to June 2000, from a total of 457 patients receiving a PEG 27 (5.9%) subjects, in whom the insertion of a PEG by means of pull-through technique was impossible or only in combination with an intervention e.g. bougienage were included in this prospective study. Each patient received a Cliny PEG 13 by means of introducer technique with endoscopically controlled double gastropexy. Tumor patients with severe stenosis made up more than 90% of the cases. The insertion and 30 day follow-up were performed using a standardized protocol. Method-related and unrelated complications were recorded. RESULTS: PEG insertion was successful in all patients without additional intervention. We did not see any method-related complications. The peri-interventional local infection rate was 3.7%. One patient died during the 30-day follow-up period as a result of progression of the underlying disease. No further complications occurred in long term follow-up. CONCLUSIONS: Our results show that the Cliny PEG 13 is a safe technique and an alternative to other methods and surgical procedures in patients in whom a PEG was not applicable by means of the pull-through technique. Larger case numbers and the use in other patient collectives will have to prove these initial results.