Pancreatic exocrine insufficiency after bariatric surgery

Guman, Maimoena S S; Olst, Nienke van; Yaman, Zehra G; Voermans, Rogier P.; Brauw, Maurits L de; Nieuwdorp, Max; Gerdes, Victor E. A.

doi:10.1016/j.soard.2021.12.017

Cited by 8 publications

(9 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results were reported in micrograms of elastase per gram of stool (µg/g). Results < 100 µg/g, 100 to 200 µg/g, and > 200 µg/g were deemed to indicate severe EPI, moderate EPI, and normal exocrine pancreatic function, respectively [ 5 , 6 , 9 ].…”

Section: Methodsmentioning

confidence: 99%

“…Vitamin and mineral deficiencies can also be experienced after bariatric surgery depending on the length of the bypassed proximal intestine [ 2 , 4 , 5 ]. That being said, asynchrony between gastric emptying and biliopancreatic secretion after bariatric surgery has been reported as the main triggering factor for EPI in this patient group [ 1 , 6 ]. However, previous studies reported controversial rates of EPI following different bariatric surgical modalities [ 1 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Bariatric surgery has been regarded as the most efficient treatment modality for obesity [ 1 , 5 ]. Although bariatric surgery reportedly leads to significant improvements in gastrointestinal complaints due to severe obesity, some of these patients can develop gastrointestinal symptoms associated with fat maldigestion, fat malabsorption, and EPI in the postoperative period [ 6 , 11 ]. Hence, there is an ongoing debate about the potential impact of gastrointestinal disturbances on the quality of life of these patients [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of Exocrine Pancreatic Function Following Bariatric/Metabolic Surgery: a Prospective Cohort Study

Okuyan

Akkuş

2022

OBES SURG

View full text Add to dashboard Cite

Background Exocrine pancreatic insufficiency (EPI) can be seen after bariatric/metabolic surgery. Fecal elastase level is a simple test in diagnosing and grading EPI. Quality of life changes in patients with bariatric/metabolic surgery related to gastrointestinal complaints is debated. Aim This study aimed to investigate rates and grades of EPI via fecal elastase levels and association between EPI and quality of life in bariatric surgery patients. Methods A prospective study was performed for patients with bariatric/metabolic surgery at their second-year follow-up. Fecal elastase levels were used to diagnose and grade EPI as severe or moderate. Patient’s gastrointestinal quality of life index (GIQLI) was calculated. Patients were grouped as sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), single-anastomosis sleeve ileal bypass (SASI), and transit bipartition (TB). Rates of severe or moderate EPI were primary outcome. Secondary outcome was an association between fecal elastase and GIQLI. Results There were 17, 29, 21, and 15 patients in OAGB, SG, TB, and SASI groups. There was no significant difference between groups in GIQLI scores and fecal elastase levels (p = 0.152 and p = 0.361). Rates of patients with moderate EPI in the groups OAGB, SG, TB, and SASI were 23.5%, 17.2%, 14.3%, and 20.0%. GIQLI scores were not significantly correlated with age, postoperative morphometric data, and fecal elastase values (p > 0.05). Conclusion Rates of patients with moderate EPI ranged from 14.3 to 23.5% at second-year follow-up. There was no patient with severe EPI. GIQLI scores were not significantly correlated with fecal elastase levels and different types of bariatric/metabolic surgery. Graphical Abstract

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of Exocrine Pancreatic Function Following Bariatric/Metabolic Surgery: a Prospective Cohort Study

Okuyan

Akkuş

2022

OBES SURG

View full text Add to dashboard Cite

show abstract

“…The alternative are non-invasive tests such as faecal elastase-I (Fe-1), however with low sensitivity and specificity falls in diagnosing mild to moderate PEI. 7,8 The specificity of this test seems to be even reduced after total and subtotal gastrectomy. [8][9][10] Therefore, diagnostics of PEI patients after gastrectomy may be difficult, as faecal elastase (Fe-1), the standard of PEI detection, may be of normal range values.…”

Section: Introductionmentioning

confidence: 99%

“…7,8 The specificity of this test seems to be even reduced after total and subtotal gastrectomy. [8][9][10] Therefore, diagnostics of PEI patients after gastrectomy may be difficult, as faecal elastase (Fe-1), the standard of PEI detection, may be of normal range values. The sensitivity of these tests is low due to its extrapancreatic mechanism of PEI in these patients.…”

Section: Introductionmentioning

confidence: 99%

Abbreviated ¹³C-mixed triglyceride breath test for detection of pancreatic exocrine insufficiency performs equally as standard 5-hour test in patients after gastrectomy performed for gastric cancer

Siuka

Kumer

Štabuc

et al. 2022

Radiology and Oncology

View full text Add to dashboard Cite

Background 13C-mixed triglyceride breath test (13C-MTGT) is a non-invasive test for the detection of moderate and severe pancreatic exocrine insufficiency (PEI), but it requires prolonged breath sampling. The aim of this study was to determine the diagnostic power of abbreviated 13C-MTGT in detecting PEI in patients after subtotal and total gastrectomy performed due to gastric cancer. Subjects and methods This cross-sectional observational study included 3 groups of subjects; healthy controls, patients with subtotal and patients with total gastrectomy. Demographic and clinical data of patients were collected. Stool samples to determine faecal elastase (Fe-1) and chymotrypsin were collected and measured by ELISA. All subjects performed 5-hour 13C-MTGT breath test. The concentration and relative content of 13C in exhaled air was measured by isotope ratio mass spectrometer (IRMS). PEI was confirmed as values of 13C-exhalation < 26.8% after 5 hours. Results Overall, 65 participants were included into analysis, 22 having PEI (n = 11 after subtotal and n = 11 after total gastrectomy, both performed for gastric cancer). 13C-MTGT breath test showed difference in percent of exhaled 13C between PEI and non-PEI patients already after 60 minutes (p = 0.034). Receiver operating characteristic (ROC) curve analysis showed that cut-off value of 13.74% after 150 minutes is showing equivalent diagnostic power to the longer test with sensitivity and specificity both above 90% for the exclusion of PEI in patients after subtotal and/or total gastrectomy. Conclusions In this study abbreviated 13C-MTGT test could be shortened from 5 to 2.5 hours without decrease in its diagnostic accuracy for detection of PEI in patients with subtotal or total gastrectomy performed for gastric cancer. This allows significant time savings in the diagnostics of PEI in this subgroup of patients.

show abstract

The influence of gastric bypass surgery on the concentration of high mobility group box 1, nuclear factor erythroid 2–related factor 2 and the genes expression of high mobility group box 1, nuclear factor erythroid2–related factor 2, interleukin 6, and tumor necrosis factor-alpha in the peripheral blood mononuclear cells of patients with morbid obesity

et al. 2022

View full text Add to dashboard Cite

Pancreatic exocrine insufficiency after bariatric surgery

Cited by 8 publications

References 18 publications

Assessment of Exocrine Pancreatic Function Following Bariatric/Metabolic Surgery: a Prospective Cohort Study

Assessment of Exocrine Pancreatic Function Following Bariatric/Metabolic Surgery: a Prospective Cohort Study

Abbreviated ¹³C-mixed triglyceride breath test for detection of pancreatic exocrine insufficiency performs equally as standard 5-hour test in patients after gastrectomy performed for gastric cancer

Contact Info

Product

Resources

About

Pancreatic exocrine insufficiency after bariatric surgery

Cited by 8 publications

References 18 publications

Assessment of Exocrine Pancreatic Function Following Bariatric/Metabolic Surgery: a Prospective Cohort Study

Assessment of Exocrine Pancreatic Function Following Bariatric/Metabolic Surgery: a Prospective Cohort Study

Abbreviated 13C-mixed triglyceride breath test for detection of pancreatic exocrine insufficiency performs equally as standard 5-hour test in patients after gastrectomy performed for gastric cancer

Contact Info

Product

Resources

About

Abbreviated ¹³C-mixed triglyceride breath test for detection of pancreatic exocrine insufficiency performs equally as standard 5-hour test in patients after gastrectomy performed for gastric cancer