Perioperative Exocrine Pancreatic Insufficiency and Pancreatic Enzyme Replacement Therapy

Introduction Exocrine Pancreatic Insufficiency is a common finding in patients requiring pancreatic surgery, and for those without evidence of preoperative exocrine pancreatic insufficiency, it frequently manifests during the postoperative period. Surgeons’ practices of assessing and treating exocrine pancreatic insufficiency are variable. We aim to define surgeons’ perception of exocrine pancreatic insufficiency and evaluate their use of pancreas enzyme replacement therapy prior to and following resection. Methods An cross sectional survey was designed and conducted to determine the surgeons role in the diagnosis and management of exocrine pancreatic insufficiency using the online tool SurveyMonkey.com. It was disseminated anonymously to members of The Pancreas Club by its website administrator. The answers were analyzed and described. Results Approximately half of the respondents (52.5%) reported assessing their patients for exocrine pancreatic insufficiency preoperatively. While 48.5% did that routinely, the rest relied on the presence of symptoms to initiate evaluation. The preferred method of assessing for exocrine pancreatic insufficiency was fecal elastase test (48%). A third of surgeons did not objectively test for exocrine pancreatic insufficiency. Half of the respondees reported prescribing pancreas enzyme replacement therapy preoperatively but only one third did so routinely. Among the other half who had never prescribed pancreas enzyme replacement therapy preoperatively, 92.6% considered prescribing it postoperatively yet only 40% did so routinely. Creon was more frequently prescribed (85.2%) over the other available formulae. We did not find a consensus on the quantity of lipase replacement units for main meals (24,000 to 108,000 units) nor for snacks (10,000 to 40,000 units). Conclusion Exocrine pancreatic insufficiency is a manageable condition that is overlooked by healthcare providers who care for pancreatic disease. A high index of suspicion should guide surgeons to start pancreas enzyme replacement therapy empirically preoperatively as part of patient optimization for surgery, and treatment should be resumed postoperatively when patients resale a solid diet.


Essa M Aleassa, Gareth Morris-Stiff

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