Pancreatic Exocrine Insufficiency after Total Gastrectomy - A Systematic Review
Adele HH Lee and Salena M Ward
Introduction Pancreatic exocrine insufficiency can cause symptoms of malabsorption after resections of the upper gastrointestinal tract. The pathophysiology is mostly attributed to anatomical alterations causing incomplete digestion, which is termed secondary pancreatic exocrine insufficiency. The aim of this systematic review was to assess the incidence of pancreatic exocrine insufficiency, diagnostic methods available and effects of pancreatic enzyme replacement therapy after total gastrectomy. Methods The literature was searched using the Pubmed database for studies on this subject over the past 50 years in accordance with the PRISMA guidelines. Results 10 studies were identified and analysed. There is a high incidence of pancreatic exocrine insufficiency in certain post-gastrectomy cohorts, ranging from 47% to 100%. Diagnosis could be assisted with the use of pancreatic exocrine function tests. Indirect tests are preferred in the setting of anatomical changes while non-invasive tests are favoured as they are less difficult to perform. There is recent evidence to suggest an improvement in quality of life with PERT post-gastrectomy, however minimal evidence to suggest a definite improvement in symptoms related to pancreatic exocrine insufficiency. Conclusion Pancreatic exocrine insufficiency is an important cause of malabsorption to consider after total gastrectomy. A trial of pancreatic enzyme replacement therapy is reasonable in symptomatic patients post-gastrectomy. High quality studies are warranted to clarify the use of pancreatic exocrine function tests and the effectiveness of PERT in improving outcomes after total gastrectomy.
