Mary E Phillips1. 1. Royal Surrey County Hospital, Regional HPB Unit, Egerton Road, Guildford GU2 7XX, United Kingdom. Electronic address: mary.phillips1@nhs.net.
Abstract
BACKGROUND/ OBJECTIVES: Untreated pancreatic exocrine dysfunction is associated with poor quality of life and reduced survival, but is difficult to diagnose following pancreatic resection. Many factors including the extent of the surgery, the health of the residual pancreas and the type of reconstruction must be considered. Patients remain undertreated, and consequently there is much debate to whether or not pancreatic enzyme replacement therapy should be routinely prescribed following pancreatic resection. METHODS: A review of the literature was undertaken to establish the incidence of PEI and factors identifying treatment. RESULTS: Forty two to forty five percent of patients undergoing pancreatico-duodenectomy (PD) experience pancreatic exocrine insufficiency pre-operatively, whilst the post-operative incidence is 56-98% in PD, and 12-80% following distal and central pancreatectomy. CONCLUSIONS: Routine use of pancreatic enzyme replacement should be considered at a starting dose of 50 to 75,000 units lipase with meals and 25,000 to 50,000 units with snacks in this patient group. Patients who have had a central or distal pancreatectomy should be individually assessed for pancreatic exocrine insufficiency in the post operative period, with those undergoing extensive resection most likely to experience insufficiency. Patients who fail to respond to pancreatic enzyme replacement therapy should be referred to a specialist dietitian, be advised on dose adjustment, and undergo investigation to exclude other gastro-intestinal pathology, including small bowel bacterial overgrowth and bile acid malabsorption.
BACKGROUND/ OBJECTIVES: Untreated pancreatic exocrine dysfunction is associated with poor quality of life and reduced survival, but is difficult to diagnose following pancreatic resection. Many factors including the extent of the surgery, the health of the residual pancreas and the type of reconstruction must be considered. Patients remain undertreated, and consequently there is much debate to whether or not pancreatic enzyme replacement therapy should be routinely prescribed following pancreatic resection. METHODS: A review of the literature was undertaken to establish the incidence of PEI and factors identifying treatment. RESULTS: Forty two to forty five percent of patients undergoing pancreatico-duodenectomy (PD) experience pancreatic exocrine insufficiency pre-operatively, whilst the post-operative incidence is 56-98% in PD, and 12-80% following distal and central pancreatectomy. CONCLUSIONS: Routine use of pancreatic enzyme replacement should be considered at a starting dose of 50 to 75,000 units lipase with meals and 25,000 to 50,000 units with snacks in this patient group. Patients who have had a central or distal pancreatectomy should be individually assessed for pancreatic exocrine insufficiency in the post operative period, with those undergoing extensive resection most likely to experience insufficiency. Patients who fail to respond to pancreatic enzyme replacement therapy should be referred to a specialist dietitian, be advised on dose adjustment, and undergo investigation to exclude other gastro-intestinal pathology, including small bowel bacterial overgrowth and bile acid malabsorption.
Authors: Jiro Kusakabe; Blaire Anderson; Jingxia Liu; Gregory A Williams; William C Chapman; Majella M B Doyle; Adeel S Khan; Dominic E Sanford; Chet W Hammill; Steven M Strasberg; William G Hawkins; Ryan C Fields Journal: J Gastrointest Surg Date: 2019-01-22 Impact factor: 3.452
Authors: Laura Nemer; Somashekar G Krishna; Zarine K Shah; Darwin L Conwell; Zobeida Cruz-Monserrate; Mary Dillhoff; Denis C Guttridge; Alice Hinton; Andrei Manilchuk; Timothy M Pawlik; Carl R Schmidt; Erin E Talbert; Tanios Bekaii-Saab; Phil A Hart Journal: Pancreas Date: 2017-10 Impact factor: 3.327
Authors: Adithya M Pathanki; Joseph A Attard; Elizabeth Bradley; Sarah Powell-Brett; Bobby V M Dasari; John R Isaac; Keith J Roberts; Nikolaos A Chatzizacharias Journal: World J Gastrointest Pathophysiol Date: 2020-04-12
Authors: Igor E Khatkov; Igor V Maev; Sayyar R Abdulkhalov; Sergey A Alekseenko; Ruslan B Allikhanov; Igor G Bakulin; Natalia V Bakulina; Andrey U Baranovskiy; Ekaterina V Beloborodova; Elena A Belousova; Sergey E Voskanyan; Lyudmila V Vinokurova; Vladimir B Grinevich; Vladimir V Darvin; Elena A Dubtsova; Tatiana G Dyuzheva; Vyacheslav I Egorov; Mikhail G Efanov; Roman E Izrailov; Vyacheslav L Korobka; Bogdan N Kotiv; Nikolay Yu Kokhanenko; Yury A Kucheryavy; Maria A Livzan; Vladimir K Lyadov; Karine A Nikolskaya; Marina F Osipenko; Victor D Pasechnikov; Ekaterina Yu Plotnikova; Oleg A Sablin; Vladimir I Simanenkov; Victor V Tsvirkun; Vladislav V Tsukanov; Alexey V Shabunin; Dmitry S Bordin; Professional Medical Society Pancreatic Club Russia Journal: Turk J Gastroenterol Date: 2021-03 Impact factor: 1.852
Authors: Mary E Phillips; Andrew D Hopper; John S Leeds; Keith J Roberts; Laura McGeeney; Sinead N Duggan; Rajesh Kumar Journal: BMJ Open Gastroenterol Date: 2021-06
Authors: Andrew E Hendifar; Maria Q B Petzel; Teresa A Zimmers; Crystal S Denlinger; Lynn M Matrisian; Vincent J Picozzi; Lola Rahib Journal: Oncologist Date: 2018-12-27 Impact factor: 5.837