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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Apr 12, 2020; 11(2): 20-31
Published online Apr 12, 2020. doi: 10.4291/wjgp.v11.i2.20
Published online Apr 12, 2020. doi: 10.4291/wjgp.v11.i2.20
Pancreatic exocrine insufficiency after pancreaticoduodenectomy: Current evidence and management
Adithya M Pathanki, Joseph A Attard, Sarah Powell-Brett, Bobby V M Dasari, John R Isaac, Keith J Roberts, Nikolaos A Chatzizacharias, Department of HPB and Liver Transplantation, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham B15 2TH, United Kingdom
Elizabeth Bradley, Department of Nutrition and Dietetics, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham B15 2TH, United Kingdom
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Nikolaos A Chatzizacharias, MD, PhD, FRCS, Consultant Surgeon, Department of HPB and liver transplantation, Queen Elizabeth Hospital, University Hospitals Birmingham, 3rd Floor, Nuffield House, Mindelsohn way, Birmingham B15 2TH, United Kingdom. chatzizacharias@gmail.com
Received: December 2, 2019
Peer-review started: December 2, 2019
First decision: December 23, 2019
Revised: March 13, 2020
Accepted: March 22, 2020
Article in press: March 22, 2020
Published online: April 12, 2020
Peer-review started: December 2, 2019
First decision: December 23, 2019
Revised: March 13, 2020
Accepted: March 22, 2020
Article in press: March 22, 2020
Published online: April 12, 2020
Core Tip
Core tip: Pancreatic exocrine insufficiency is highly prevalent after pancreaticoduodenectomy and has significant implications to patients’ quality of life, nutrition, post-operative survival and cancer related outcomes. The published literature reveals no uniform definition of pancreatic exocrine insufficiency after surgery and patients are often under diagnosed. Pancreatic enzyme replacement therapy is effective, well tolerated and is indicated routinely in this cohort of patients. Future studies need to focus on the identification of a well-tolerated, reliable and reproducible diagnostic test in this setting that will facilitate a uniform definition and management approach.