Exocrine pancreatic insufficiency and pancreatic enzyme supplementation after gastric resection-A scoping review.

Abstract

Exocrine pancreatic insufficiency (EPI) frequently occurs following gastric resection, although it remains underdiagnosed and insufficiently managed. While pancreatic enzyme supplementation (PES) is the cornerstone of the management of EPI, substantial evidence endorsing its application post-gastric surgery is scarce. This scoping review assesses the occurrence of EPI following gastric resection and the influence of PES in managing these patient populations. All relevant studies related to EPI and PES in patients with gastric resection were reviewed until November 2024. Patient demographics, clinical profiles, method of assessment and prevalence of EPI and the effect of PES were analyzed. Total 14 studies reported EPI after gastric resection and three analyzed the outcome of PES after gastric resection. There was considerable variability in the methodologies employed to evaluate EPI following gastric resection. Earlier studies employed direct tests; however, newer studies have utilized indirect tests, predominantly the fecal elastase test. Both studies employing direct tests indicated an EPI prevalence rate of 100%, whereas those utilizing indirect tests revealed a prevalence rate between 26.8% and 100% (26.8% to 63.8% with fecal elastase). Only four studies reported on the severity of EPI following stomach resection, with significant variability. Lastly, there was a lack of high-quality evidence indicating the benefits of PES following gastric resection. Future studies are needed to develop criteria that facilitate the diagnosis of EPI in individuals who have undergone gastrectomy. Robust clinical trials are necessary to provide definitive proof of PES's efficacy in enhancing patient outcomes.