Prevalence of pancreatic exocrine insufficiency after pancreatic surgery measured by 13C mixed triglyceride breath test: A prospective cohort study |
| |
| Institution: | 1. Antwerp University Hospital, Department of HPB, Endocrine and Transplantation Surgery, Drie Eikenstraat 655, 2650, Edegem, Belgium;2. University of Antwerp, Belgium;1. Department of General Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey;2. Department of Radiology, Faculty of Medicine, Mersin University, Mersin, Turkey;7. CH Cornouaille, Quimper, France;8. Beaujon Hospital, Clichy, France;9. Dupuytren University Hospital, Limoges, France;10. CHU Rangueil, Toulouse, France;11. Hôpital Tenon (AP-HP), Paris, France;12. CHU Nantes, Nantes, France;13. CH Cholet, Cholet, France;14. Hospital of Saint-Etienne, Saint-Etienne, France;15. CHI d''Aulnay-sous-Bois, Aulnay-sous-Bois, France;p. Avignon Hospital, Avignon, France;q. Le Havre Hospital, Le Havre, France;r. Hospital of Saint-Etienne, St-Etienne, France;s. University Hospital Croix Rousse, Lyon, France;t. HIA Clermont-Tonnerre, Brest, France;u. CHU Estaing, Clermont Ferrand, France;v. CH Saint Brieuc, Saint-Brieuc, France;w. CHU Reims, Reims, France;x. Saint Antoine Hospital, Paris, France;y. CHR Orléans, Orléans, France;z. CHRU Strasbourg, Strasbourg, France;11. CHU Brest, Brest, France;12. Hôpital Antoine-Béclère, Clamart, France;13. Hôpital Louis Mourier, Colombes, France;14. CH Cahors, Cahors, France;15. CHU Clermont-Ferrand, Clermont-Ferrand, France;16. CH Chartres, Chartres, France;17. CHU Dijon, Dijon, France;18. CHU Grenoble, Grenoble, France;19. Hôpital Pasteur, Colmar, France;110. CH Saint-Malo, Saint-Malo, France;111. Pellegrin-Enfants Hospital, Bordeaux, France;112. Hôpital de la Timone Enfants, Marseille, France;113. CH Blois, Blois, France;114. Archet II Hospital, Nice, France;115. CH des Escartons, Briançon, France;1p. Hôpital privé Jean Mermoz, Lyon, France;1q. Hôpital de Mulhouse, Mulhouse, France;1r. Institut Paoli Calmettes, Marseille, France;1s. CHU Rennes, Rennes, France;1t. Timone University Hospital, Marseille, France;1u. CH Bretagne Atlantique, Vannes, France;1v. CH Dax-Côte d''Argent, Dax, France;1w. GH Diaconesses, Paris, France;1x. CHI Villeneuve Saint Georges, Créteil, France;1y. Hôpital Femme Mère Enfant, Bron, France;1z. CH Chartres, Le Coudray, France;21. Hôpital d''instruction des armées Percy, Clamart, France;22. Beaujon Hospital, Paris, France;23. University Hospital of Besançon, Besançon, France;24. Clinique Sainte Barbe, Strasbourg, France;25. CHU Poitiers, Poitiers, France;26. CHU Amiens, Amiens;27. Rouen University Hospital, Rouen, France;28. Trousseau Hospital, Tours, France;29. Angers University Hospital, Angers, France;210. Bichat Hospital, Paris, France;211. Edouard Herriot Hospital, Lyon, France;212. CH Saint Joseph Saint Luc, Lyon, France;213. CHI de Créteil, Créteil, France;214. Clinique Charcot, Saint Foy les Lyon, France;215. Hôpital Dreux, Dreux, France;2p. CHU Bordeaux, Bordeaux, France;2q. Poitiers University Hospital, Poitiers, France;2r. CH Melun, Melun, France;2s. Hôpital Saint-Eloi, Montpellier, France;2t. CH Bastia, Bastia, France;1. Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France;2. Service de Génétique Médicale et de Biologie de la Reproduction, CHRU Brest, F-29200, Brest, France;3. Service de Pédiatrie, Hépato-Gastro-Entérologie et Nutrition Pédiatrique, Hôpitaux Pédiatriques de Nice CHU Lenval, Nice, France;4. Service d''Hépato-Gastroentérologie et Assistance Nutritionnelle, Institut des Maladies de l''Appareil Digestif (IMAD), Centre Hospitalo-Universitaire (CHU), Nantes, France;5. Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, United Kingdom;6. Pancreatology and Digestive Oncology Department, Beaujon Hospital, APHP - Clichy, Université Paris Cité, Paris, France;1. Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA;2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA;3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA;1. Pancreatic Disease Centre, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China;2. Liverpool Pancreatitis Research Group, Liverpool University Hospitals NHS Foundation Trust and Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK;3. Department of Gynecology and Obstetrics, The First Affiliated Hospital of Nanchang University, Nanchang, China;4. West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China;5. Department of Emergency, The First Affiliated Hospital of Nanchang University, Nanchang, China;6. Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China;7. Department of Pediatrics, Neonatal Intensive Care Unit, The First Affiliated Hospital of Nanchang University, Nanchang, China;8. Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China |
| |
| Abstract: | BackgroundPatients undergoing pancreatic surgery are at risk of pancreatic exocrine insufficiency (PEI) and needing pancreatic enzyme replacement therapy (PERT).MethodsThis study included 254 patients undergoing pancreatic surgery for oncologic indications. A13C mixed triglyceride breath test was performed immediately preoperative and postoperative. This test analyzes the pancreatic remnant lipase activity measuring 13CO2 in breath samples after a test meal with 1.3-distearyl-(13C-Carboxyl)octanol-glycerol. Cumulative percent dose recovery after 6 h of less than 23% confirms PEI. In addition, PEI was compared between pathology subgroups.ResultsIn 197 patients undergoing pancreaticoduodenectomy, cPDR-6h decreased significantly from a median of 32.84% before to 15.80% after surgery (p < 0.0001). This decrease in exocrine function was significant in all pathology subgroups except in pancreatic neuroendocrine tumors. Exocrine function decreased most in pancreatic ductal adenocarcinoma (PDAC). In addition, the percentage of patients needing PERT because of PEI increased from 25.9% to 68.0% postoperative (p < 0.001). Overall, patients with an MPD diameter of more than 3 mm had a higher risk of developing postoperative PEI: 62.7% compared to 37.3% (p = 0.009), OR = 3.11.In contrast, the majority of the 57 patients undergoing a distal pancreatectomy did not experience any significant change in exocrine function.ConclusionsThe vast majority of patients undergoing pancreaticoduodenectomy for oncologic indications experience a significant drop in exocrine function, are at high risk of developing pancreatic exocrine insufficiency and consequently need to be treated with pancreatic enzyme replacement therapy. Therefore, systematic screening for pancreatic exocrine insufficiency is needed after pancreaticoduodenectomy. |
| |
| Keywords: | Pancreatic function Pancreatic exocrine insufficiency Pancreatic ductal adenocarcinoma Pancreaticoduodenectomy Distal pancreatectomy |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
