Exocrine pancreatic insufficiency after bariatric surgery: a bariatric surgery center of excellence experience

Moore, Hope N; Chirco, Alexis R; Plescia, Trevor; Ahmed, Sheikh Z.; Jachniewicz, Barbara; Rajasekar, Ganesh; Ali, Mohamed R.; Lyo, Victoria

doi:10.1007/s00464-022-09388-3

Cited by 9 publications

(5 citation statements)

References 42 publications

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“…The difference between the two surgeries is that in sleeve gastrectomy, the vagal nerve is preserved, and food passes through the duodenum, whereas in gastrectomy for gastric cancer, the vagal nerve is resected, and food does not pass through the duodenum after Roux-en-Y reconstruction. It has been reported that Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch, which do not pass through the duodenum, are more likely to cause pancreatic exocrine insufficiency than sleeve gastrectomy [21]. Decreased stimulation of the pancreas via the vagal nerve and secretin and cholecystokinin, whose secretion is accelerated when meals pass through the duodenum, may be responsible for the decreased pancreatic secretory function as well as PV after gastrectomy.…”

Section: Discussionmentioning

confidence: 99%

Gastrectomy reduces pancreatic secretory function via pancreatic atrophy

et al. 2023

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Purpose Although reports suggest that the pancreatic volume decreases after gastrectomy for gastric cancer, the relationship between the pancreatic volume and secretory function after gastrectomy remains unclear. In this study, we examined the relationship between the pancreatic volume and exocrine and endocrine functions after total gastrectomy. Methods The pancreatic volumes of 18 distal gastrectomy and 15 total gastrectomy patients were retrospectively measured using computed tomography volumetry up to 5 years postoperatively. Ten low anterior resection patients were selected as controls. In addition, the pancreatic volume and exocrine function evaluated by fecal elastase and the insulin secretory function evaluated by glucagon tolerance testing were prospectively examined before and one year after surgery in nine cases of total gastrectomy. Results After low anterior resection, the pancreatic volume did not change, but after distal and total gastrectomy, the pancreatic volume decreased continuously until the fifth year. After total gastrectomy, fecal elastase decreased significantly from 865.8 μg/g to 603.2 μg/g in the first year (p = 0.0316), and the insulin secretion capacity also decreased significantly from 3.83 ng/mL to 2.26 ng/mL (p = 0.0019). Conclusions The pancreatic volume decreases continuously after gastrectomy for gastric cancer, and the pancreatic exocrine and endocrine functions decrease along with pancreatic atrophy after total gastrectomy.

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Section: Discussionmentioning

confidence: 99%

Gastrectomy reduces pancreatic secretory function via pancreatic atrophy

et al. 2023

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“…The optimal limb length to provide desirable weight loss without causing severe malnutrition and nutrient deficiencies is still under debate; it is important for the clinician to monitor for signs and symptoms of micronutrient deficiencies. Of note, a recent publication found that 47.9% of their patients who underwent RYGB and 70% of their patients who underwent BPD‐DS had EPI 27 …”

Section: Disease States With High Risk For Epimentioning

confidence: 99%

“…Of note, a recent publication found that 47.9% of their patients who underwent RYGB and 70% of their patients who underwent BPD-DS had EPI. 27…”

Section: Stool Characteristicsmentioning

confidence: 99%

Exocrine pancreatic insufficiency and pancreatic exocrine replacement therapy in clinical practice

Berry,

Bilbo

2024

Nut in Clin Prac

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Exocrine pancreatic insufficiency (EPI) is a complex condition that disrupts normal digestion and absorption. Patients with EPI may suffer from mild to debilitating malabsorption with a constellation of symptoms that can have a significant effect on quality of life and nutrition status. Pancreatic enzyme replacement therapy (PERT) is effective and safe to treat EPI and is the standard of care for this condition. A wide variety and various forms of these products exist, as well as numerous guidelines and recommendations. Obtaining PERT for patients can oftentimes be cost prohibitive. Determining the presence and extent of EPI can be challenging and patient specific, making it difficult for practitioners. This narrative review will explore these issues, as well as several disease states potentially affected by EPI, and review current management strategies.

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“…The operation associated with the least EPI is sleeve gastrectomy followed by increasing EPI with Roux‐en‐Y gastric bypass (RYGB), and the most EPI is observed with the duodenal switch operation. In a study from the University of California‐Davis, Moore et al reported an incidence of 17.4% for sleeve gastrectomy, 47.9% after RYGB, and 70% after a duodenal switch procedure was performed 26 …”

Section: Nonpancreatic Surgery and Fat Malabsorptionmentioning

confidence: 99%

“…In a study from the University of California-Davis, Moore et al reported an incidence of 17.4% for sleeve gastrectomy, 47.9% after RYGB, and 70% after a duodenal switch procedure was performed. 26 In relation to the etiology of EPI following bariatric surgery, many potential factors have been identified as summarized in Table 3. In none of the procedures is pancreatic tissue resected so tissue loss is not an issue; however, for RYGB and duodenal switch, there are significant rearrangements in the anatomy, so physiological asynchrony is likely a major contributing factor.…”

Section: Bariatric Weight Loss Surgerymentioning

confidence: 99%

Exocrine pancreatic insufficiency and fat malabsorption related to pancreatectomy and other gastrointestinal surgery: A narrative review

Morris‐Stiff

2024

Nut in Clin Prac

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Surgical resection is the mainstay of treatment for patients with tumors of the pancreas. There are a number of well‐recognized complications that account for the significant morbidity associated with the operation, including exocrine pancreatic insufficiency (EPI). Patients with pancreatic cancer commonly have evidence of EPI prior to surgery, and this is exacerbated by an operation, the extent of the insult being dependent on the indication for surgery and the operation performed. There are accumulating data to demonstrate that treatment of EPI with pancreatic enzyme replacement (PERT) enhances clinical outcomes after surgery by reducing critical complications; this in turn may enhance oncological outcomes. Data would indicate that quality of life (QoL) is also improved after surgery when enzymes are prescribed. To date, many surgeons and clinicians have not appreciated the need for PERT or the benefits it may bring to their patients; therefore, education of clinicians remains a significant opportunity. In turn, patient education about consumption of the correct dose of enzymes at the appropriate time is key to an optimal outcome. In addition, because of the complex nature of the regulation of pancreatic exocrine function, there is evidence to support the presence of EPI following operations performed on other gastrointestinal (GI) organs, including the esophagus, stomach, and small intestine. The aim of this review is to document the existing published evidence in relation to EPI and its treatment with PERT following GI surgery.

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Exocrine pancreatic insufficiency after bariatric surgery: a bariatric surgery center of excellence experience

Cited by 9 publications

References 42 publications

Gastrectomy reduces pancreatic secretory function via pancreatic atrophy

Gastrectomy reduces pancreatic secretory function via pancreatic atrophy

Exocrine pancreatic insufficiency and pancreatic exocrine replacement therapy in clinical practice

Exocrine pancreatic insufficiency and fat malabsorption related to pancreatectomy and other gastrointestinal surgery: A narrative review

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