Post-surgical exocrine pancreatic insufficiency.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Digestive Health

Background:

• Surgical pancreatic exocrine insufficiency (PSP) is an underdiagnosed gastrointestinal (GI) condition resulting from upper GI tract, biliary, or pancreatic surgery.
• It leads to insufficient pancreatic enzyme production, causing malabsorption, malnutrition, and reduced quality of life.
• Risk factors include age, obesity, smoking, diabetes history, malignancy, steatorrhea, jaundice, weight loss, and intraoperative pancreatic texture.

Purpose of the Study:

• To review the diagnosis and management of surgical pancreatic exocrine insufficiency (PSP).
• To highlight the prevalence of PSP after various pancreatic and GI surgeries.
• To emphasize the importance of timely treatment with pancreatic enzyme replacement therapy (PERT).

Main Methods:

• Literature review of studies on surgical pancreatic exocrine insufficiency (PSP).
• Analysis of PSP prevalence data across different surgical procedures (PD, DP, CenP) and chronic pancreatitis (CP) interventions.
• Review of diagnostic tools like fecal elastase-1 (FE-1) and treatment guidelines for PERT.

Main Results:

• Pancreatoduodenectomy (PD) shows a high PSP prevalence (19-100%), while Distal Pancreatectomy (DP) and Central Pancreatectomy (CenP) have lower rates (0-82% and 3.66-8.7%).
• Specific CP procedures like Partington-Rochelle and Frey also report high PSP rates (>80%).
• Fecal elastase-1 (FE-1) is a validated diagnostic marker, and PERT effectively manages symptoms.

Conclusions:

• PSP is a significant complication of GI and pancreatic surgery, often underdiagnosed and undertreated.
• Accurate diagnosis using FE-1 and prompt initiation of PERT are essential for patient outcomes.
• Ongoing monitoring for malnutrition and tailored PERT dosage are recommended for PSP management.