Pancreatic exocrine insufficiency after pancreatic resection: a systematic review.

IF 1.6 3区 医学 Q2 SURGERY
Marcello Di Martino, Ángela de la Hoz Rodriguez, Andrea Saibanti, Guillermo Salvador Camarmo, Nico Pagano, Elena Martín-Pérez, Matteo Donadon
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Abstract

Introduction: Pancreatic exocrine insufficiency (PEI) is a condition defined by a reduction in pancreatic exocrine activity that impairs normal digestion. Despite established guidelines recommendations, precise diagnosis of PEI after pancreatic resection are infrequently achieved. This review aims to provide a comprehensive overview of the methodology and accuracy of diagnostic tools available for evaluating PEI after pancreatic resection.

Methods: A review of PEI diagnostic tests was conducted using a combined text and MeSH search strategy to identify relevant articles focused on post-pancreatectomy PEI diagnosis.

Results: The literature search yielded 4,874 records, and 30 studies were included in the analysis, with a total of 2,305 patients. The reported frequency of PEI across the included studies varied widely, though more than two-thirds of included papers reported an incidence of PEI above 65% in patients who underwent pancreatoduodenectomy or distal pancreatectomy. The faecal elastase-1 (FE-1) test was the most frequently used test for diagnosing post-pancreatectomy PEI. Six studies compared the diagnostic accuracy of FE-1 with faecal fat tests or 13 C breath tests, finding no significant differences. Five studies reported on micronutrient deficiencies.

Conclusion: The FE-1 test is the most commonly used diagnostic tool for post-pancreatectomy PEI; however, well-designed studies comparing the diagnostic accuracy of various tests for PEI are lacking. Additionally, few studies report on micronutrient deficiencies, variations in anthropometric data or PEI-related patient-reported outcomes. Future studies should aim to establish a gold standard for diagnosis and severity assessment of post-pancreatectomy PEI and provide guidance for tailored pancreatic enzyme replacement therapy.

胰腺外分泌功能不全(PEI)是一种由胰腺外分泌活性降低而影响正常消化的疾病。尽管有既定的指导建议,但胰腺切除术后PEI的精确诊断很少实现。这篇综述的目的是提供一个全面的方法和诊断工具的准确性评估胰腺切除术后PEI。方法:使用结合文本和MeSH搜索策略对PEI诊断测试进行回顾,以确定专注于胰腺切除术后PEI诊断的相关文章。结果:文献检索获得4874条记录,纳入30项研究,共计2305例患者。在纳入的研究中,PEI的报道频率差异很大,尽管超过三分之二的纳入的论文报道,在接受胰十二指肠切除术或远端胰腺切除术的患者中,PEI的发病率超过65%。粪便弹性酶-1 (FE-1)试验是诊断胰腺切除术后PEI最常用的试验。6项研究比较了FE-1与粪便脂肪测试或13项C呼气测试的诊断准确性,没有发现显著差异。五项研究报告了微量营养素缺乏症。结论:FE-1检查是胰腺切除术后PEI最常用的诊断工具;然而,目前缺乏设计良好的研究来比较各种PEI检查的诊断准确性。此外,很少有研究报告微量营养素缺乏,人体测量数据的变化或pei相关患者报告的结果。未来的研究应旨在建立胰腺切除术后PEI诊断和严重程度评估的金标准,并为量身定制胰酶替代治疗提供指导。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Surgery
BMC Surgery SURGERY-
CiteScore
2.90
自引率
5.30%
发文量
391
审稿时长
58 days
期刊介绍: BMC Surgery is an open access, peer-reviewed journal that considers articles on surgical research, training, and practice.
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