Elsevier

ESMO Open

Volume 7, Issue 1, February 2022, 100386
ESMO Open

Review
Expert opinion on management of pancreatic exocrine insufficiency in pancreatic cancer

https://doi.org/10.1016/j.esmoop.2022.100386Get rights and content
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Highlights

  • PEI is a common condition in PC patients and should be actively looked for in PC patients and treated with PERT.

  • In resected and borderline resectable patients PERT should be started as soon as possible when PEI is clinically suspected.

  • Early PERT start is key to have resected and borderline resectable patients as fit as possible before cancer treatments.

  • In unresectable patients, a confirmation of PEI via an indirect test is recommended before PERT initiation.

  • A cornerstone of PERT is proper patient education on its use and adequate patient follow-up to adapt to therapy as needed.

Pancreatic exocrine insufficiency (PEI) is a common condition in patients with pancreatic cancer (PC). PEI can be due to the tumor, which, if located in the head, causes obstruction of the pancreatic duct with subsequent atrophy of the pancreatic parenchyma, or it can be the consequence of pancreatic surgical resection. The standard treatment of PEI is pancreatic enzyme replacement therapy (PERT). Clinical data to support the use of PERT in PC are however limited. There are very few randomized clinical trials that evaluated PERT in PC. Most data come from observational studies. Despite this limited clinical evidence, PERT treatment for PEI is an essential part of supportive therapy to ensure optimal nutritional status in PC patients who will receive surgery, neoadjuvant/adjuvant or palliative treatment. The objective of this review is to increase the awareness about PEI in PC patients and to provide expert recommendations on the use of PERT in resected, borderline resectable and unresectable patients, based on clinical experience and literature review.

Key words

pancreatic cancer
pancreatic exocrine insufficiency
pancreatic enzyme replacement therapy

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