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Exocrine pancreatic insufficiency after bariatric surgery: a bariatric surgery center of excellence experience

  • 2022 SAGES Oral
  • Published:
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Abstract

Introduction

Gastrointestinal symptoms such as diarrhea, bloating, abdominal pain, and nausea are common after bariatric surgery (BS) and can lead to significant morbidity. While many diagnoses can explain these symptoms, post-bariatric exocrine pancreatic insufficiency (EPI) is becoming increasingly recognized as contributor to gastrointestinal symptoms. The frequency and outcomes of EPI after BS are not well understood. We investigated the prevalence and outcomes of EPI over 18 years at a tertiary bariatric referral center.

Methods

A retrospective review of patients who underwent primary or revisional BS from 2002 to 2020 was performed. Patients were included if they were suspected of having EPI or underwent fecal elastase testing (FE-1). EPI diagnosis was defined as positive FE-1 testing or improvement with empiric pancreatic enzyme replacement therapy (PERT).

Results

EPI was suspected in 261 patients, and 190 were tested via FE-1 (89.5%) or empirically treated (10.5%). EPI was diagnosed in 79 (41.6%) patients and was associated with older age and lower BMI. Therapeutic PERT was given to 65 patients diagnosed with EPI, and 56 (86.2%) patients reported improved symptoms. Patients who underwent RYGB and BPD-DS were more likely to have EPI than those after SG (47.9% and 70.0% vs 17.4%, p < 0.01). EPI diagnosis was associated with a history chronic pancreatitis. While diarrhea and abdominal pain were the most common symptoms prompting FE-1 testing, no symptoms were significantly associated with EPI. EPI was also associated with abnormal fecal fat results and treatment with bile acid sequestrants, but not small intestinal bacterial overgrowth.

Conclusion

This study highlights that exocrine pancreatic insufficiency can account to for previously unexplained GI complaints after bariatric surgery. Therefore, bariatric surgery programs should consider this diagnosis in symptomatic patients, especially following RYGB and BPD-DS. Further work to define patient factors that should prompt evaluation, optimal treatment, and prevention is necessary.

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Acknowledgements

We would like to thank Jeffrey Flack for assistance with electronic medical record data gathering. The project described used RedCAP, which was supported by the National Center for Advancing Translation Sciences (NCATS), National Institutes of Health (NIH), through grand UL1 TR001860.

Funding

This was an unfunded project.

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Authors and Affiliations

  1. Department of Surgery, University of California Davis Health, Sacramento, CA, USA

    Hope N. Moore, Trevor Plescia, Shushmita Ahmed, Barbara Jachniewicz, Ganesh Rajasekar, Mohamed R. Ali & Victoria Lyo

  2. University of California, Davis, CA, USA

    Alexis R. Chirco

  3. UC Davis Medical Center, 2335 Stockton Blvd., NAOB 6113, Sacramento, CA, 95817, USA

    Victoria Lyo

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  1. Hope N. Moore
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Correspondence to Victoria Lyo.

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Drs. Nicole Moore, Trevor Plescia, Shushmita Ahmed, Barbara Jachniewicz, Mohamed Ali, Alexis R. Chirco, Ganesh Rajasekar and Victoria Lyo have no interests or financial ties to disclose.

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Moore, H.N., Chirco, A.R., Plescia, T. et al. Exocrine pancreatic insufficiency after bariatric surgery: a bariatric surgery center of excellence experience. Surg Endosc 37, 1466–1475 (2023). https://doi.org/10.1007/s00464-022-09388-3

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