Pancreatic Enzyme Replacement Therapy for Postoperative Pancreatic Exocrine Insufficiency after Pancreatic Resection

Abstract

Objective : With the increased survival period following pancreatectomy, postoperative pancreatic exocrine insufficiency (PEI) has become an important issue. Pancrelipase (LipaCreon^®) is used as pancreatic enzyme replacement therapy, but clear criteria for its administration and its maintenance have not been established. This study aimed to clarify these criteria.

Methods : A total of 223 patients who underwent pancreatectomy in our department were retrospectively reviewed, focusing on the timing of pancrelipase initiation, reasons for use, duration, dosage, surgical procedure, and factors for discontinuation.

Results : Of the 223 patients, 70 (31%) were diagnosed with postoperative PEI and were treated with pancrelipase ; of them, 58 (83%) began its administration within one year after surgery, primarily due to fatty liver or diarrhea. The duration of its administration ranged from 1 month to 4 years (median : 6 months). Approximately 70% received its dose of 900 mg, and a limited number of patients received the recommended dose of 1800 mg.

Conclusion : Careful observation for fatty liver and diarrhea within the first year postoperatively enabled appropriate therapy in with PEI. A half-dose regimen was sufficient in the majority of cases.