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
ARTICLE HIGHLIGHTS
Research background

Pancreatic surgery for various disease processes (including both malignancy and benign disease) have been described for many years but only recently have techniques improved making certain metabolic consequences more known. De novo non-alcoholic fatty liver disease (NAFLD) has been associated with pancreatectomy after about 12 mo but risk factors are not well known given the heterogeneous populations that have been studied thus far.

Research motivation

Given the improvement in surgical techniques used for pancreatectomy, mortality has improved which has led to increased awareness of downstream metabolic effects. One of those effects, the development of de novo NAFLD, is especially interesting given the lack of traditional metabolic risk factors that are often associated with fatty liver disease. Therefore, there is more importance in defining risk factors that could lead to development of de novo NAFLD so that prevention and treatment can also be better defined.

Research objectives

To summarize the various per-operative risk factors that lead to development of de novo NAFLD after pancreatectomy along with potential management and treatment options.

Research methods

A literature search from 2001 to 2022 was done and all study designs that investigated de novo NAFLD were included.

Research results

With an incidence rate up to 75%, de novo NAFLD can develop within 12 mo after pancreatectomy. Various risk factors have been established including pancreatic resection line and remnant pancreas volume, peri-operative malnutrition and weight loss, EPI, pancreatic endocrine insufficiency, malignancy as the indication for surgery, and postmenopausal status.

Research conclusions

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

Research perspectives

Future studies should focus on per-operative management of nutrition including pancreatic enzyme replacement therapy while monitoring weight change and development, prevention, or improvement of de novo fatty liver disease.