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Exocrine pancreatic insufficiency after bariatric surgery
Joshua Y Kwon1, Alfred Nelson2, Ahmed Salih2
1Department of Medicine, Mayo Clinic, Jacksonville, FL, USA.
Summary
Exocrine pancreatic insufficiency (EPI) occurred in 9.3% of bariatric surgery patients. Roux-en-Y gastric bypass (RYGB) was linked to higher EPI rates than gastric sleeve (GS) surgery, indicating a need for clinical awareness.
Area of Science:
- Gastroenterology
- Bariatric Surgery
- Pancreatic Physiology
Background:
- Exocrine pancreatic insufficiency (EPI) is a known complication following upper gastrointestinal surgery.
- Recent evidence suggests an association between EPI and bariatric surgery procedures.
Purpose of the Study:
- To determine the incidence of EPI in patients undergoing bariatric surgery.
- To identify specific bariatric procedures associated with a higher risk of EPI.
Main Methods:
- Retrospective cohort analysis of patients aged 18+ who underwent bariatric surgery between 2010-2020.
- Exclusion criteria included prior GI/hepatobiliary surgery, bariatric revisions, pre-existing EPI, or surgery >10 years prior.
- Comparison of patient characteristics between Roux-en-Y gastric bypass (RYGB) and gastric sleeve (GS) groups, and analysis of RYGB patients with and without post-operative steatorrhea.
Main Results:
- The study included 150 patients: 126 RYGB and 24 GS.
- Post-operative steatorrhea occurred in 20.6% and EPI was diagnosed in 9.3% of patients.
- RYGB patients showed a significantly higher incidence of post-operative steatorrhea compared to GS patients (p=0.029).
Conclusions:
- The incidence of EPI post-bariatric surgery in this cohort was 9.3%.
- RYGB procedures were associated with higher EPI rates (10.3%) compared to GS (4.2%).
- Clinicians should consider EPI in bariatric surgery patients presenting with steatorrhea and evaluate for enzyme replacement therapy.
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