Exocrine Pancreatic Insufficiency

Key clinical point: Lipomatous pseudohypertrophy (LPH) of the pancreas is a rare disease with varied clinical presentation and different signs and symptoms. It could be a cause of exocrine pancreatic insufficiency (EPI) and thus requires patient follow-up and appropriate treatment.

Major finding: LPH of pancreas was diagnosed in a 26-year-old man under evaluation. Computed tomography scan and magnetic resonance imaging showed a diffusely enlarged pancreas with scattered remnants of pancreatic parenchyma. Pancreatic exocrine and endocrine functions were maintained as pockets of pancreatic parenchyma were preserved. The patient was discharged with an advice for regular follow-ups.

Study details: Findings are from analysis of a 26-year-old man admitted to hospital with loss of appetite for 6 months.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Luu VD et al. Radiology Case Reports. 2021 Apr 9. doi: 10.1016/j.radcr.2021.03.045.

Key clinical point: Lipomatous pseudohypertrophy (LPH) of the pancreas is a rare disease with varied clinical presentation and different signs and symptoms. It could be a cause of exocrine pancreatic insufficiency (EPI) and thus requires patient follow-up and appropriate treatment.

Major finding: LPH of pancreas was diagnosed in a 26-year-old man under evaluation. Computed tomography scan and magnetic resonance imaging showed a diffusely enlarged pancreas with scattered remnants of pancreatic parenchyma. Pancreatic exocrine and endocrine functions were maintained as pockets of pancreatic parenchyma were preserved. The patient was discharged with an advice for regular follow-ups.

Study details: Findings are from analysis of a 26-year-old man admitted to hospital with loss of appetite for 6 months.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Luu VD et al. Radiology Case Reports. 2021 Apr 9. doi: 10.1016/j.radcr.2021.03.045.

Key clinical point: Lipomatous pseudohypertrophy (LPH) of the pancreas is a rare disease with varied clinical presentation and different signs and symptoms. It could be a cause of exocrine pancreatic insufficiency (EPI) and thus requires patient follow-up and appropriate treatment.

Major finding: LPH of pancreas was diagnosed in a 26-year-old man under evaluation. Computed tomography scan and magnetic resonance imaging showed a diffusely enlarged pancreas with scattered remnants of pancreatic parenchyma. Pancreatic exocrine and endocrine functions were maintained as pockets of pancreatic parenchyma were preserved. The patient was discharged with an advice for regular follow-ups.

Study details: Findings are from analysis of a 26-year-old man admitted to hospital with loss of appetite for 6 months.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Luu VD et al. Radiology Case Reports. 2021 Apr 9. doi: 10.1016/j.radcr.2021.03.045.

Key clinical point: Over a 10-year period, an unexpected high prevalence of vitamin D overdosing was observed in patients with cystic fibrosis with odds of overdose higher in patients suffering from exocrine pancreatic insufficiency (EPI).

Major finding: Severe vitamin D overdose was observed in 5.3% of patients, with 2 patients developing clinical toxicity and presenting with severe hypercalcemia, hypercalciuria, and acute kidney injury necessitating hospitalization and monitoring. Patients experiencing vitamin D overdose were more likely to suffer from EPI or were homozygous for F508del.

Study details: Findings are from a retrospective review of 244 patients with a diagnosis of cystic fibrosis and at least 1 measure of serum 25(OH)D.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Planté-Bordeneuve T et al. Sci Rep. 2021 Apr 8. doi: 10.1038/s41598-021-87099-w.

Key clinical point: Over a 10-year period, an unexpected high prevalence of vitamin D overdosing was observed in patients with cystic fibrosis with odds of overdose higher in patients suffering from exocrine pancreatic insufficiency (EPI).

Major finding: Severe vitamin D overdose was observed in 5.3% of patients, with 2 patients developing clinical toxicity and presenting with severe hypercalcemia, hypercalciuria, and acute kidney injury necessitating hospitalization and monitoring. Patients experiencing vitamin D overdose were more likely to suffer from EPI or were homozygous for F508del.

Study details: Findings are from a retrospective review of 244 patients with a diagnosis of cystic fibrosis and at least 1 measure of serum 25(OH)D.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Planté-Bordeneuve T et al. Sci Rep. 2021 Apr 8. doi: 10.1038/s41598-021-87099-w.

Key clinical point: Over a 10-year period, an unexpected high prevalence of vitamin D overdosing was observed in patients with cystic fibrosis with odds of overdose higher in patients suffering from exocrine pancreatic insufficiency (EPI).

Major finding: Severe vitamin D overdose was observed in 5.3% of patients, with 2 patients developing clinical toxicity and presenting with severe hypercalcemia, hypercalciuria, and acute kidney injury necessitating hospitalization and monitoring. Patients experiencing vitamin D overdose were more likely to suffer from EPI or were homozygous for F508del.

Study details: Findings are from a retrospective review of 244 patients with a diagnosis of cystic fibrosis and at least 1 measure of serum 25(OH)D.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Planté-Bordeneuve T et al. Sci Rep. 2021 Apr 8. doi: 10.1038/s41598-021-87099-w.

Key clinical point: Overt exocrine insufficiency is rare in patients with pancreatic trauma but some asymptomatic patients may show biochemical exocrine insufficiencies on specific investigations, particularly after pancreatic resection.

Major finding: Severe pancreatic exocrine insufficiency (PEI) was seen in 4 patients (20%), of which 3 had undergone pancreatic resection (P = .7). Only 1 patient complained of steatorrhea. Patients undergoing pancreatic resection had lower fecal elastase than those who did not (median, 113 μg/g vs. 162.5 μg/g), although difference was not significant statistically (P = .7).

Study details: Findings are from analysis of 20 patients with grade 2-5 pancreatic injury (age, 18-65 years) who were admitted and managed at the division of Trauma Surgery and Critical Care. Patients either underwent partial pancreatic resection (n=12) or nonoperative management or operation without resection (n=8).

Disclosures: The study did not receive any funding. The authors declared no conflicts of interest.

Source: Colney L et al. Eur J Trauma Emerg Surg. 2021 Mar 14. doi: 10.1007/s00068-021-01638-8.

Key clinical point: Overt exocrine insufficiency is rare in patients with pancreatic trauma but some asymptomatic patients may show biochemical exocrine insufficiencies on specific investigations, particularly after pancreatic resection.

Major finding: Severe pancreatic exocrine insufficiency (PEI) was seen in 4 patients (20%), of which 3 had undergone pancreatic resection (P = .7). Only 1 patient complained of steatorrhea. Patients undergoing pancreatic resection had lower fecal elastase than those who did not (median, 113 μg/g vs. 162.5 μg/g), although difference was not significant statistically (P = .7).

Study details: Findings are from analysis of 20 patients with grade 2-5 pancreatic injury (age, 18-65 years) who were admitted and managed at the division of Trauma Surgery and Critical Care. Patients either underwent partial pancreatic resection (n=12) or nonoperative management or operation without resection (n=8).

Disclosures: The study did not receive any funding. The authors declared no conflicts of interest.

Source: Colney L et al. Eur J Trauma Emerg Surg. 2021 Mar 14. doi: 10.1007/s00068-021-01638-8.

Key clinical point: Overt exocrine insufficiency is rare in patients with pancreatic trauma but some asymptomatic patients may show biochemical exocrine insufficiencies on specific investigations, particularly after pancreatic resection.

Major finding: Severe pancreatic exocrine insufficiency (PEI) was seen in 4 patients (20%), of which 3 had undergone pancreatic resection (P = .7). Only 1 patient complained of steatorrhea. Patients undergoing pancreatic resection had lower fecal elastase than those who did not (median, 113 μg/g vs. 162.5 μg/g), although difference was not significant statistically (P = .7).

Study details: Findings are from analysis of 20 patients with grade 2-5 pancreatic injury (age, 18-65 years) who were admitted and managed at the division of Trauma Surgery and Critical Care. Patients either underwent partial pancreatic resection (n=12) or nonoperative management or operation without resection (n=8).

Disclosures: The study did not receive any funding. The authors declared no conflicts of interest.

Source: Colney L et al. Eur J Trauma Emerg Surg. 2021 Mar 14. doi: 10.1007/s00068-021-01638-8.

Key clinical point: During long-term follow-up, exocrine pancreatic insufficiency (EPI) was observed in more than half of the patients who underwent curative gastrectomy and had completed oncological treatment for gastric adenocarcinoma. Postoperative radiotherapy as an adjunct to adjuvant chemotherapy was a serious risk factor for EPI development.

Major finding: Fecal elastase-1 (FE-1) less than 200 μg/g, considered a measure of EPI, was present in 63.8% of patients. A higher proportion of patients with low FE-1 (less than 100 μg/g) received adjuvant chemoradiotherapy vs. those with moderate FE-1 (100-200 μg/g; P = .012) and normal FE-1 (less than 200 μg/g; P less than .001).

Study details: This study included 69 patients with gastric cancer who underwent total or subtotal curative gastrectomy with D2 lymphadenectomy and had long-term disease-free survival success. Patients were followed up for 16-120 months.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Surmelioglu A et al. Pancreatology. 2021 Apr 1. doi: 10.1016/j.pan.2021.03.019.

Key clinical point: During long-term follow-up, exocrine pancreatic insufficiency (EPI) was observed in more than half of the patients who underwent curative gastrectomy and had completed oncological treatment for gastric adenocarcinoma. Postoperative radiotherapy as an adjunct to adjuvant chemotherapy was a serious risk factor for EPI development.

Major finding: Fecal elastase-1 (FE-1) less than 200 μg/g, considered a measure of EPI, was present in 63.8% of patients. A higher proportion of patients with low FE-1 (less than 100 μg/g) received adjuvant chemoradiotherapy vs. those with moderate FE-1 (100-200 μg/g; P = .012) and normal FE-1 (less than 200 μg/g; P less than .001).

Study details: This study included 69 patients with gastric cancer who underwent total or subtotal curative gastrectomy with D2 lymphadenectomy and had long-term disease-free survival success. Patients were followed up for 16-120 months.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Surmelioglu A et al. Pancreatology. 2021 Apr 1. doi: 10.1016/j.pan.2021.03.019.

Key clinical point: During long-term follow-up, exocrine pancreatic insufficiency (EPI) was observed in more than half of the patients who underwent curative gastrectomy and had completed oncological treatment for gastric adenocarcinoma. Postoperative radiotherapy as an adjunct to adjuvant chemotherapy was a serious risk factor for EPI development.

Major finding: Fecal elastase-1 (FE-1) less than 200 μg/g, considered a measure of EPI, was present in 63.8% of patients. A higher proportion of patients with low FE-1 (less than 100 μg/g) received adjuvant chemoradiotherapy vs. those with moderate FE-1 (100-200 μg/g; P = .012) and normal FE-1 (less than 200 μg/g; P less than .001).

Study details: This study included 69 patients with gastric cancer who underwent total or subtotal curative gastrectomy with D2 lymphadenectomy and had long-term disease-free survival success. Patients were followed up for 16-120 months.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Surmelioglu A et al. Pancreatology. 2021 Apr 1. doi: 10.1016/j.pan.2021.03.019.

The following two studies are related to additional at-risk patient populations for exocrine pancreatic insufficiency. In a single-center cross-sectional study out of Italy, researchers demonstrated that EPI is a feature of type 1 diabetes—compared with healthy individuals, fecal elastase-1 levels were significantly lower in participants with new-onset and long-standing T1D (P = .0070 and .0010, respectively). Notably the study showed correlation between progressive exocrine and endocrine function throughout the natural history of disease. Certainly, further research is needed to clarify the pathogenesis and role of EPI in type 1 diabetes.

Lastly the final selection comes from AIIMS in India, where they assessed endocrine and exocrine function in patients following pancreatic trauma. Notably, of the 20 patients studied with trauma, 11 of them (55%) had evidence of pancreatic exocrine insufficiency by fecal elastase measurement. 4 patients had severe pancreatic insufficiency, 3 of which had partial pancreatectomy (with mean pancreatic volume of 48.65cm3 following surgery). Classic teaching is that EPI develops when exocrine function is impaired by ~90%, however in the resection groups, they have demonstrated severe EPI in patients with roughly 50% retained pancreatic volume.   

The following two studies are related to additional at-risk patient populations for exocrine pancreatic insufficiency. In a single-center cross-sectional study out of Italy, researchers demonstrated that EPI is a feature of type 1 diabetes—compared with healthy individuals, fecal elastase-1 levels were significantly lower in participants with new-onset and long-standing T1D (P = .0070 and .0010, respectively). Notably the study showed correlation between progressive exocrine and endocrine function throughout the natural history of disease. Certainly, further research is needed to clarify the pathogenesis and role of EPI in type 1 diabetes.

Lastly the final selection comes from AIIMS in India, where they assessed endocrine and exocrine function in patients following pancreatic trauma. Notably, of the 20 patients studied with trauma, 11 of them (55%) had evidence of pancreatic exocrine insufficiency by fecal elastase measurement. 4 patients had severe pancreatic insufficiency, 3 of which had partial pancreatectomy (with mean pancreatic volume of 48.65cm3 following surgery). Classic teaching is that EPI develops when exocrine function is impaired by ~90%, however in the resection groups, they have demonstrated severe EPI in patients with roughly 50% retained pancreatic volume.   

The following two studies are related to additional at-risk patient populations for exocrine pancreatic insufficiency. In a single-center cross-sectional study out of Italy, researchers demonstrated that EPI is a feature of type 1 diabetes—compared with healthy individuals, fecal elastase-1 levels were significantly lower in participants with new-onset and long-standing T1D (P = .0070 and .0010, respectively). Notably the study showed correlation between progressive exocrine and endocrine function throughout the natural history of disease. Certainly, further research is needed to clarify the pathogenesis and role of EPI in type 1 diabetes.

Lastly the final selection comes from AIIMS in India, where they assessed endocrine and exocrine function in patients following pancreatic trauma. Notably, of the 20 patients studied with trauma, 11 of them (55%) had evidence of pancreatic exocrine insufficiency by fecal elastase measurement. 4 patients had severe pancreatic insufficiency, 3 of which had partial pancreatectomy (with mean pancreatic volume of 48.65cm3 following surgery). Classic teaching is that EPI develops when exocrine function is impaired by ~90%, however in the resection groups, they have demonstrated severe EPI in patients with roughly 50% retained pancreatic volume.   

Key clinical point: The sphere size is not an essential parameter for selecting effective pancreatin preparations for patients with exocrine pancreatic insufficiency (EPI).

Major finding: One study reported faster emptying of 2 mm pellets than a pancake meal in patients with pancreatic disease. Another study reported parallel emptying of liver pate and 1.5 mm pellets (range, 1.0-1.5 mm). One study reported no clear pattern in stomach emptying for pancreatin pellets of less than 1.2 mm. Emptying of pancreatin preparations with a particle size of up to 7 mm is also documented in the postprandial phase in healthy individuals.

Study details: Meta-analysis of 26 studies that evaluated gastric emptying of indigestible particles of different sizes in healthy volunteers or patients with EPI under fed conditions.

Disclosures: This meta-analysis was supported by Nordmark. The authors received consulting fees outside of this work.

Citation: Peterson K-U. J Gastrointestin Liver Dis. 2021 Mar 12. doi: 10.15403/jgld-2985.

Key clinical point: The sphere size is not an essential parameter for selecting effective pancreatin preparations for patients with exocrine pancreatic insufficiency (EPI).

Major finding: One study reported faster emptying of 2 mm pellets than a pancake meal in patients with pancreatic disease. Another study reported parallel emptying of liver pate and 1.5 mm pellets (range, 1.0-1.5 mm). One study reported no clear pattern in stomach emptying for pancreatin pellets of less than 1.2 mm. Emptying of pancreatin preparations with a particle size of up to 7 mm is also documented in the postprandial phase in healthy individuals.

Study details: Meta-analysis of 26 studies that evaluated gastric emptying of indigestible particles of different sizes in healthy volunteers or patients with EPI under fed conditions.

Disclosures: This meta-analysis was supported by Nordmark. The authors received consulting fees outside of this work.

Citation: Peterson K-U. J Gastrointestin Liver Dis. 2021 Mar 12. doi: 10.15403/jgld-2985.

Key clinical point: The sphere size is not an essential parameter for selecting effective pancreatin preparations for patients with exocrine pancreatic insufficiency (EPI).

Major finding: One study reported faster emptying of 2 mm pellets than a pancake meal in patients with pancreatic disease. Another study reported parallel emptying of liver pate and 1.5 mm pellets (range, 1.0-1.5 mm). One study reported no clear pattern in stomach emptying for pancreatin pellets of less than 1.2 mm. Emptying of pancreatin preparations with a particle size of up to 7 mm is also documented in the postprandial phase in healthy individuals.

Study details: Meta-analysis of 26 studies that evaluated gastric emptying of indigestible particles of different sizes in healthy volunteers or patients with EPI under fed conditions.

Disclosures: This meta-analysis was supported by Nordmark. The authors received consulting fees outside of this work.

Citation: Peterson K-U. J Gastrointestin Liver Dis. 2021 Mar 12. doi: 10.15403/jgld-2985.

Key clinical point: In patients with advanced pancreatic cancer, pancreatic enzyme replacement therapy (PERT) for exocrine pancreatic insufficiency (EPI) does not affect survival.

Major finding: There was no significant difference in the overall survival in patients who received PERT vs. those who did not (weighted estimate, 9.5 months vs. 8.1 months; P = .464). No PERT-related adverse events were reported.

Study details: A meta-analysis of 4 randomized controlled trials including 194 patients with pancreatic cancer. The patients with EPI received PERT.

Disclosures: No specific sponsor was identified. One reviewer received personal fees from Abbott Pharmaceuticals and Mylan.

Citation: Ammar K. Expert Rev Gastroenterol Hepatol. 2021 Feb 15. doi: 10.1080/17474124.2021.1884544.

Key clinical point: In patients with advanced pancreatic cancer, pancreatic enzyme replacement therapy (PERT) for exocrine pancreatic insufficiency (EPI) does not affect survival.

Major finding: There was no significant difference in the overall survival in patients who received PERT vs. those who did not (weighted estimate, 9.5 months vs. 8.1 months; P = .464). No PERT-related adverse events were reported.

Study details: A meta-analysis of 4 randomized controlled trials including 194 patients with pancreatic cancer. The patients with EPI received PERT.

Disclosures: No specific sponsor was identified. One reviewer received personal fees from Abbott Pharmaceuticals and Mylan.

Citation: Ammar K. Expert Rev Gastroenterol Hepatol. 2021 Feb 15. doi: 10.1080/17474124.2021.1884544.

Key clinical point: In patients with advanced pancreatic cancer, pancreatic enzyme replacement therapy (PERT) for exocrine pancreatic insufficiency (EPI) does not affect survival.

Major finding: There was no significant difference in the overall survival in patients who received PERT vs. those who did not (weighted estimate, 9.5 months vs. 8.1 months; P = .464). No PERT-related adverse events were reported.

Study details: A meta-analysis of 4 randomized controlled trials including 194 patients with pancreatic cancer. The patients with EPI received PERT.

Disclosures: No specific sponsor was identified. One reviewer received personal fees from Abbott Pharmaceuticals and Mylan.

Citation: Ammar K. Expert Rev Gastroenterol Hepatol. 2021 Feb 15. doi: 10.1080/17474124.2021.1884544.

Key clinical point: Presence of exocrine pancreatic insufficiency (EPI) in patients with cystic fibrosis is associated with lower levels of phytosterol and cholesterol. Pancreatic enzyme supplement improves cholesterol levels in these patients.

Major finding: Total fat and cholesterol intake were higher in patients with cystic fibrosis. Total cholesterol, low-density lipoprotein cholesterol, campesterol, and β-sitosterol levels were significantly lower in cystic fibrosis patients with EPI vs. those without (all P less than .05). The rate of hypocholesterolemia was lower in patients with EPI receiving a supplementation dose of greater than 2500 U of lipase/g of fat (P = .0026).

Study details: The study included 55 patients with cystic fibrosis and 45 healthy adults. Forty-eight patients with cystic fibrosis had EPI (fecal elastase-1 concentrations less than 100 µg/g) and received pancreatic enzymes.

Disclosures: The study was supported by the Polish National Science Centre. The authors declared no conflicts of interest.

Citation: Drzymała-Czyż S et al. Biomolecules. 2021 Feb 19. doi: 10.3390/biom11020313.

Key clinical point: Presence of exocrine pancreatic insufficiency (EPI) in patients with cystic fibrosis is associated with lower levels of phytosterol and cholesterol. Pancreatic enzyme supplement improves cholesterol levels in these patients.

Major finding: Total fat and cholesterol intake were higher in patients with cystic fibrosis. Total cholesterol, low-density lipoprotein cholesterol, campesterol, and β-sitosterol levels were significantly lower in cystic fibrosis patients with EPI vs. those without (all P less than .05). The rate of hypocholesterolemia was lower in patients with EPI receiving a supplementation dose of greater than 2500 U of lipase/g of fat (P = .0026).

Study details: The study included 55 patients with cystic fibrosis and 45 healthy adults. Forty-eight patients with cystic fibrosis had EPI (fecal elastase-1 concentrations less than 100 µg/g) and received pancreatic enzymes.

Disclosures: The study was supported by the Polish National Science Centre. The authors declared no conflicts of interest.

Citation: Drzymała-Czyż S et al. Biomolecules. 2021 Feb 19. doi: 10.3390/biom11020313.

Key clinical point: Presence of exocrine pancreatic insufficiency (EPI) in patients with cystic fibrosis is associated with lower levels of phytosterol and cholesterol. Pancreatic enzyme supplement improves cholesterol levels in these patients.

Major finding: Total fat and cholesterol intake were higher in patients with cystic fibrosis. Total cholesterol, low-density lipoprotein cholesterol, campesterol, and β-sitosterol levels were significantly lower in cystic fibrosis patients with EPI vs. those without (all P less than .05). The rate of hypocholesterolemia was lower in patients with EPI receiving a supplementation dose of greater than 2500 U of lipase/g of fat (P = .0026).

Study details: The study included 55 patients with cystic fibrosis and 45 healthy adults. Forty-eight patients with cystic fibrosis had EPI (fecal elastase-1 concentrations less than 100 µg/g) and received pancreatic enzymes.

Disclosures: The study was supported by the Polish National Science Centre. The authors declared no conflicts of interest.

Citation: Drzymała-Czyż S et al. Biomolecules. 2021 Feb 19. doi: 10.3390/biom11020313.

Key clinical point: Impaired exocrine pancreatic function is reported in a subgroup of patients undergoing esophagectomy, and pancreatic enzyme replacement therapy can improve symptoms and body weight in these patients.

Major finding: Fecal elastase-1 levels of less than 200 µg/g were reported in 16%-18% of patients at 4-6 months following esophagectomy. Pancreatic enzyme replacement therapy (25,000-50,000 units lipase per meal) improved gastrointestinal symptoms, body weight, and normalized stool in patients with steatorrhea.

Study details: Systematic review of 3 prospective cohort studies reporting exocrine pancreatic insufficiency (EPI) in 107 patients undergoing esophagectomy.

Disclosures: No sponsor was identified for this review.

Citation: Blonk L et al. Dis Esophagus. 2021 Feb 9. doi: 10.1093/dote/doab003.

Key clinical point: Impaired exocrine pancreatic function is reported in a subgroup of patients undergoing esophagectomy, and pancreatic enzyme replacement therapy can improve symptoms and body weight in these patients.

Major finding: Fecal elastase-1 levels of less than 200 µg/g were reported in 16%-18% of patients at 4-6 months following esophagectomy. Pancreatic enzyme replacement therapy (25,000-50,000 units lipase per meal) improved gastrointestinal symptoms, body weight, and normalized stool in patients with steatorrhea.

Study details: Systematic review of 3 prospective cohort studies reporting exocrine pancreatic insufficiency (EPI) in 107 patients undergoing esophagectomy.

Disclosures: No sponsor was identified for this review.

Citation: Blonk L et al. Dis Esophagus. 2021 Feb 9. doi: 10.1093/dote/doab003.

Key clinical point: Impaired exocrine pancreatic function is reported in a subgroup of patients undergoing esophagectomy, and pancreatic enzyme replacement therapy can improve symptoms and body weight in these patients.

Major finding: Fecal elastase-1 levels of less than 200 µg/g were reported in 16%-18% of patients at 4-6 months following esophagectomy. Pancreatic enzyme replacement therapy (25,000-50,000 units lipase per meal) improved gastrointestinal symptoms, body weight, and normalized stool in patients with steatorrhea.

Study details: Systematic review of 3 prospective cohort studies reporting exocrine pancreatic insufficiency (EPI) in 107 patients undergoing esophagectomy.

Disclosures: No sponsor was identified for this review.

Citation: Blonk L et al. Dis Esophagus. 2021 Feb 9. doi: 10.1093/dote/doab003.

Key clinical point: Asymptomatic patients with pancreatic trauma may have exocrine insufficiency when evaluated with specific investigations.

Major finding: Patients who underwent pancreatic resection had a lower fecal elastase value vs. those who did not, but the difference was not statistically significant (113 vs. 162.5 μg/g; P = .7). One patient in the resection group reported steatorrhea. Three patients in the pancreatic resection and 1 in the nonresection group had severe pancreatic exocrine insufficiency (P = .7). No patient required pancreatic enzyme supplements.

Study details: A study of 20 patients (mean age, 25 years) with pancreatic trauma between June 2016 and December 2017. Partial pancreatic resection was performed in 12 patients. Exocrine functions were evaluated with the fecal elastase test at 6 months.

Disclosures: No study sponsor was identified.

Citation: Colney L et al. Eur J Trauma Emerg Surg. 2021 Mar 14. doi: 10.1007/s00068-021-01638-8.

Key clinical point: Asymptomatic patients with pancreatic trauma may have exocrine insufficiency when evaluated with specific investigations.

Major finding: Patients who underwent pancreatic resection had a lower fecal elastase value vs. those who did not, but the difference was not statistically significant (113 vs. 162.5 μg/g; P = .7). One patient in the resection group reported steatorrhea. Three patients in the pancreatic resection and 1 in the nonresection group had severe pancreatic exocrine insufficiency (P = .7). No patient required pancreatic enzyme supplements.

Study details: A study of 20 patients (mean age, 25 years) with pancreatic trauma between June 2016 and December 2017. Partial pancreatic resection was performed in 12 patients. Exocrine functions were evaluated with the fecal elastase test at 6 months.

Disclosures: No study sponsor was identified.

Citation: Colney L et al. Eur J Trauma Emerg Surg. 2021 Mar 14. doi: 10.1007/s00068-021-01638-8.

Key clinical point: Asymptomatic patients with pancreatic trauma may have exocrine insufficiency when evaluated with specific investigations.

Major finding: Patients who underwent pancreatic resection had a lower fecal elastase value vs. those who did not, but the difference was not statistically significant (113 vs. 162.5 μg/g; P = .7). One patient in the resection group reported steatorrhea. Three patients in the pancreatic resection and 1 in the nonresection group had severe pancreatic exocrine insufficiency (P = .7). No patient required pancreatic enzyme supplements.

Study details: A study of 20 patients (mean age, 25 years) with pancreatic trauma between June 2016 and December 2017. Partial pancreatic resection was performed in 12 patients. Exocrine functions were evaluated with the fecal elastase test at 6 months.

Disclosures: No study sponsor was identified.

Citation: Colney L et al. Eur J Trauma Emerg Surg. 2021 Mar 14. doi: 10.1007/s00068-021-01638-8.