Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2022; 10(35): 12946-12958
Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.12946
De novo non-alcoholic fatty liver disease after pancreatectomy: A systematic review
Parth Shah, Vanisha Patel, Motaz Ashkar
Parth Shah, Motaz Ashkar, Gastroenterology, Washington University in Saint Louis, Saint Louis, MO 63110, United States
Vanisha Patel, Internal Medicine, Washington University in Saint Louis, Saint Louis, MO 63110, United States
Author contributions: All authors participated in gathering articles, synthesizing data, and writing the paper.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRSIAM 2009 Checklist.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Motaz Ashkar, MBBS, MS, Assistant Professor, Staff Physician, Gastroenterology, Washington University in Saint Louis, 660 S. Euclid Avenue, Saint Louis, MO 63110, United States. motaz.ashkar@wustl.edu
Received: August 24, 2022
Peer-review started: August 24, 2022
First decision: September 25, 2022
Revised: October 10, 2022
Accepted: November 22, 2022
Article in press: November 22, 2022
Published online: December 16, 2022
Abstract
BACKGROUND

As operative techniques and mortality rates of pancreatectomy have improved, there has been a shift in focus to maintaining and improving the nutritional status of these patients as we continue to learn more about post-operative complications. Although pancreatic endocrine and exocrine insufficiencies are known complications of pancreatectomy, increased longevity of these patients has also led to a higher incidence of de novo fatty liver disease which differs from traditional fatty liver disease given the lack of metabolic syndrome.

AIM

To identify and summarize patterns and risk factors of post-pancreatectomy de novo fatty liver disease to guide future management.

METHODS

We performed a database search on PubMed selecting papers published between 2001 and 2022 in the English language. PubMed was last accessed 1 June 2022.

RESULTS

Various factors influence the development of de novo fatty liver including indication for surgery (benign vs malignant), type of pancreatectomy, amount of pancreas remnant, and peri-operative nutritional status. With an incidence rate up to 75%, de novo non-alcoholic fatty liver disease (NAFLD) can develop within 12 mo after pancreatectomy and various risk factors have been established including pancreatic resection line and remnant pancreas volume, peri-operative malnutrition and weight loss, pancreatic exocrine insufficiency (EPI), malignancy as the indication for surgery, and postmenopausal status.

CONCLUSION

Since majority of risk factors leads to EPI and malnutrition, peri-operative focus on nutrition and enzymes replacement is key in preventing and treating de novo NAFLD after pancreatectomy.

Keywords: Pancreatectomy, De novo fatty liver, Pancreatic Insufficiency, Malnutrition

Core Tip: As surgical techniques for pancreatectomy have improved, patients have had an improvement in mortality which has allowed further investigation into the metabolic changes after surgery. Currently there are no guidelines on the management or prevention of de novo non-alcoholic fatty liver disease (NAFLD) after pancreatectomy. In this review, we synthesize both the patterns and risk factors of de novo NAFLD to help guide management.