Pancreatic exocrine insufficiency following pancreatoduodenectomy: A prospective bi-center study

Background/objectivesPancreatic 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 defi...

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Published in:Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] Vol. 22; no. 7; pp. 1020 - 1027
Main Authors: 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.
Format: Journal Article
Language:English
Published: Philadelphia Elsevier Limited 01-11-2022
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Summary:Background/objectivesPancreatic 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.MethodsA bi-centre prospective observational cohort study was 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.ResultsIn 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.DiscussionThis 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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ISSN:1424-3903
1424-3911
DOI:10.1016/j.pan.2022.08.002