Alysha R Keehn, MD, MSc, candidate1, Stephen N Quigley, MD, FRCSC2, Elijah Dixon, MD, MSc, FRCSC1. 1University of Calgary, Department of Surgery, 2Memorial University, Department of Surgery
Background: Mortality from pancreatic surgery has decreased over the years, however morbidity remains high. 45% of patients demonstrate pancreatic exocrine insufficiency prior to surgery with post-operative incidences ranging form 56-98%. This contributes to poor quality of life, readmission to hospital and reduced survival.
Objectives: Few studies have reported on the efficacy of pancreatic enzyme replacement therapy following pancreatic surgery. The aim of this review is to systematically summarize the evidence to guide and inform practice.
Methods: A systematic review was conducted using Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL & Google Scholar. Bibliographies of all included publications were cross-referenced. PRISMA guidelines were used to structure the review and evidence was appraised using the GRADE system.
Results: Eleven studies were included (4 prospective observational and 7 RCTs). Pancreatic enzyme replacement therapy was found to significantly reduce fecal fat excretion (p<0.001) in 3 RCTs and significantly reduce stool frequency (p<0.001) in 1 RCT. It was found to significantly improve both the coefficient of fat absorption and of nitrogen absorption (p<0.001, 0.05 respectively) in 2 RCT’s. There is mixed evidence for whether PERT improves mean body weight and BMI. 3 RCT’s showed an improvement in clinical symptomatology with PERT while 1 found no difference.
Conclusion: There is grade A evidence to support that PERT reduces fecal fat excretion and improves stool frequency, and fat/nitrogen absorption. There is mixed evidence (Grade C) that it has an effect on mean body weight and BMI. There is Grade A evidence to support a reduction in clinical symptoms. The data from this systematic review will be used in a subsequent meta-analysis.
Key Words: Pancreatic exocrine insufficiency, pancreatic enzyme replacement therapy, pancrealipase, CREON®, pancreatic surgery, pancreaticoduodenectomy
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95389
Program Number: P228
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster