Pancreatic Exocrine Insufficiency after Bariatric Surgery

Abstract

Morbid obesity is a lifelong disease, and all patients require complementary follow-up including nutritional surveillance by a multidisciplinary team after bariatric procedures. Pancreatic exocrine insufficiency (PEI) refers to an insufficient secretion of pancreatic enzymes and/or sodium bicarbonate. PEI is a known multifactorial complication after upper gastrointestinal surgery, and might constitute an important clinical problem due to the large number of bariatric surgical procedures in the world. Symptoms of PEI often overlap with sequelae of gastric bypass, making the diagnosis difficult. Steatorrhea, weight loss, maldigestion and malabsorption are pathognomonic for both clinical conditions. Altered anatomy after bypass surgery can make the diagnostic process even more difficult. Fecal elastase-1 (FE1) is a useful diagnostic test. PEI should be considered in all patients after bariatric surgery with prolonged gastrointestinal complaints that are suggestive of maldigestion and/or malabsorption. Appropriate pancreatic enzyme replacement therapy should be part of the treatment algorithm in patients with confirmed PEI or symptoms suggestive of this complication.

Keywords: bariatric surgery; exocrine; insufficiency; obesity; pancreas.

Figure 1

(A) Pre-operative anatomy; (B) Adjustable gastric band with subcutaneous port; (C) Vertical-banded gastroplasty; (D) Sleeve gastrectomy; (E) Roux-en-Y gastric bypass; (F) Biliopancreatic diversion; (G) Biliopancreatic diversion with gastric sleeve and duodenal switch.