Pancreatic exocrine insufficiency after pancreaticoduodenectomy is more prevalent with pancreaticogastrostomy than with pancreaticojejunostomy. A retrospective multicentre observational cohort study

Abstract

Objective: Recently, pancreaticogastrostomy (PG) has attracted renewed interest as a reconstruction technique after pancreaticoduodenectomy (PD), as it may imply a lower risk of clinical pancreatic fistula than reconstruction by pancreaticojejunostomy (PJ). We hypothesise that pancreatic exocrine insufficiency (PEI) is more common during clinical follow-up after PG than it is after PJ. Research design and methods:This study compares the prevalence of PEI in patients undergoing PD for malignancy with reconstruction by PG versus reconstruction by PJ. PEI during the first year of followup was defined as the intake of pancreatic enzyme replacement therapy (PERT) within one year postoperatively and/or an abnormal exocrine function test.Results: A total of 186 patients, having undergone surgery at two university hospitals, were included in the study. PEI during the first year postoperatively was present in 75.0% of the patients with PG, compared to 45.7% with PJ (p < 0.001). Intake of PERT within one year after surgery was found to be more prevalent in the PG group, i.e. 75.8% versus 38.5% (p < 0.001). There was a trend towards more disturbed exocrine function tests after PG (p = 0.061).Conclusions: PEI is more common with PG reconstruction than with PJ reconstruction after pancreaticoduodenectomy for malignancy.

<p>Exocrine pancreatic insufficiency: prevalence, diagnosis, and management</p>

“…Different procedures are associated with different degrees of EPI: Whipple procedure (pancreatic duodenectomy) determines the highest rate of EPI (85%–95%), which is slightly lower for pylorus-preserving intervention (80%–90%) 15. Similarly, pancreaticojejunum anastomosis is associated with lower rates of EPI compared to gastropancreatic one 16. Distal pancreatectomy is associated with a much lower rate of EPI (20%–50%) 17…”

“…15 Similarly, pancreaticojejunum anastomosis is associated with lower rates of EPI compared to gastropancreatic one. 16 Distal pancreatectomy is associated with a much lower rate of EPI (20%–50%). 17 …”

Actualización en el manejo nutricional de la insuficiencia pancreática exocrina: revisión de la literatura

“…El procedimiento de Whipple (duodenopancreatectomía cefálica) determina la tasa más alta de IPE (85 %-95 %), pero la misma es ligeramente menor para la intervención con preservación del píloro (80 %-90 %) (20) . De manera similar, la anastomosis pancreática-yeyunal se asocia con tasas más bajas de IPE en comparación con la gastropancreática (30) . La pancreatectomía distal se asocia con una tasa más baja de IPE (20 % -50 %) (21,22) .…”

Pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy to prevent post-operative pancreatic fistula, a dissonance between evidence and practice

“…It has been proposed that lack of enterokinase and acidic environment in stomach inactivates pancreatic enzymes, which along with good blood supply of stomach may have role to play in reducing risk of anastomotic leak [19]. While potential of anastomotic leak is reduced by pancreaticogastrostomy, long term exocrine and endocrine functions are compromised more in these patients as compared to those who underwent pancreaticojejunostomy [20]. Furthermore risk of digestive tract bleeding is also more after pancreaticogastrostomy, though management of GI bleed is easy via upper gastrointestinal endoscopy should bleeding occur [21].…”