Pancreatic exocrine insufficiency following pancreatoduodenectomy: A prospective bi-center study
Kroon, V J; Daamen, L A; Tseng, D S J; de Vreugd, A Roele-; Brada, L J H; Busch, O R; Derksen, T C; Gerritsen, A; Rombouts, S J E; Smits, F J; Walma, M S; Wennink, R A W; Besselink, M G; van Santvoort, H C; Molenaar, I Q
(2022) Pancreatology, volume 22, issue 7, pp. 1020 - 1027
(Article)
Abstract
BACKGROUND/OBJECTIVES: Pancreatic exocrine insufficiency (PEI) is a common complication following pancreatoduodenectomy (PD) leading to malnutrition. The course of PEI and related symptoms and vitamin deficiencies is unknown. This study aimed to assess the (long-term) incidence of PEI and vitamin deficiencies after PD. METHODS: A bi-centre prospective observational cohort study was
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performed, including patients who underwent PD for mainly pancreatic and periampullary (pre)malignancies (2014-2018). Two cohorts were formed to evaluate short and long-term results. Patients were followed for 18 months and clinical symptoms were evaluated by questionnaire. PEI was based on faecal elastase-1 (FE-1) levels and/or clinical symptoms. RESULTS: In total, 95 patients were included. After three months, all but three patients had developed PEI and 27/29 (93%) patients of whom stool samples were available showed abnormal FE-1 levels, which did not improve during follow-up. After six months, all patients had developed PEI. During follow-up, symptoms resolved in 35%-70% of patients. Vitamin D and K deficiencies were observed in 48%-79% of patients, depending on the moment of follow-up; 0%-50% of the patients with deficiencies received vitamin supplementation. DISCUSSION: This prospective study found a high incidence of PEI after PD with persisting symptoms in one-to two thirds of all patients. Limited attention was paid to vitamin deficiencies. Improved screening and treatment strategies for PEI and vitamins need to be designed.
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Keywords: Exocrine Pancreatic Insufficiency/epidemiology, Humans, Pancreas, Pancreaticoduodenectomy/adverse effects, Prospective Studies, Vitamin A, pancreatic cancer, pancreatic surgery, pancreatic enzyme replacement therapy, Pancreatic exocrine insufficiency, Gastroenterology, Endocrinology, Diabetes and Metabolism, Hepatology, Observational Study, Journal Article
ISSN: 1424-3903
Publisher: S. Karger AG
Note: Funding Information: This work was supported by an unrestricted research grant from Mylan Healthcare B.V., a Viatris company and from the University Medical Center Utrecht , Utrecht, the Netherlands. Funding Information: The diagnosis of PEI is generally based upon clinical symptoms and can be supported by laboratory faecal testing. Typical manifestations of PEI include steatorrhea, weight loss, muscle wasting, foul smelling stools, malabsorption, and flatulence [2,7,8]. Malabsorption caused by PEI, resulting in malnutrition, can be reflected by the presence of serum vitamin A, D, E and K deficiencies [9]. Laboratory tests are direct tests such as 72-h faecal fat excretion, and indirect tests such as faecal elastase-1 (FE-1) [10]. Of these, FE-1 testing is most commonly used, as it is easy, quick and non-invasive. Elastase-1 is an enzyme produced by the pancreas and excreted in the faeces, which gives an approximation of the pancreatic exocrine function [11]. Nevertheless, the diagnostic accuracy of FE-1 is only moderate, given that its correlation with severity of clinical symptoms following resection for (pre)malignancies was found to be mediocre [ 11–13].This work was supported by an unrestricted research grant from Mylan Healthcare B.V., a Viatris company and from the University Medical Center Utrecht, Utrecht, the Netherlands. Publisher Copyright: © 2022 The Authors
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