Clinical outcomes of pancrelipase administration after pancreaticoduodenectomy

This study investigated the risk factors for nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD) and the need for prophylactic pancrelipase administration in all patients.

This study included 180 patients who underwent PD between 2007 and 2023. Persistent liver dysfunction and severe diarrhea after PD are indications for pancrelipase administration. We retrospectively investigated the relationship between clinical variables and the postoperative development of NAFLD and the use of pancrelipase after PD.

A total of 36 (20%) patients developed NAFLD after PD. Age < 75 years old, female sex, pancreatic cancer, persistent liver dysfunction, and pancrelipase administration were identified as risk factors for the development of NAFLD in the univariate analysis, and age < 75 years old, female sex, and persistent liver dysfunction were identified as risk factors in the multivariate analysis. In total, 42 (23%) patients were administered pancrelipase, of whom 14 (33%) developed NAFLD. In contrast, among the 138 patients not administered pancrelipase, 116 (84%) did not develop NAFLD (p = 0.014).

Age < 75 years old, female sex, and persistent liver dysfunction were significantly associated with NAFLD development after PD. Many patients do not develop NAFLD after PD, even without the administration of pancrelipase. Prophylactic pancrelipase may not be necessary for all patients after PD.