Effects of pancrelipase on hepatic steatosis after pancreaticoduodenectomy

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Introduction: Development of hepatic steatosis after pancreaticoduodenectomy has recently become recognized. Although the precise mechanism of hepatic steatosis after pancreaticoduodenectomy has remained unclear, a very small number of reports have suggested that hepatic steatosis after pancreaticoduodenectomy is associated with pancreatic exocrine insufficiency. The aim of this study was to clarify whether pancrelipase, which contains digestive pancreatic enzymes, could reverse the development of hepatic steatosis after pancreaticoduodenectomy. Methods: Data from 74 consecutive patients who underwent pancreaticoduodenectomy between May 2009 and October 2011 were reviewed. The 15 patients who recieved 1800 mg of pancrelipase daily after October 2013 were included in the final analysis. For each patient, the average CT attenuation values in four sectors of the liver and in one region of the spleen were monitored for evaluation of hepatic fat content before and after surgery and 6 months after starting treatment. Results: Although the mean hepatic attenuation value and liver-to-spleen attenuation ratio decreased significantly after pancreaticoduodenectomy (59.2 HU vs. 35.2 HU; p < 0.05, 1.24 vs. 0.74; p < 0.05, respectively), the mean hepatic attenuation value and liver-to-spleen attenuation ratio increased significantly after treatment with pancrelipase (35.2 HU vs. 51.9 HU; p < 0.05, 0.74 vs. 1.11; p < 0.05, respectively). The incidence of hepatic steatosis, which was defined as a liver-to-spleen attenuation ratio less than 0.9, decreased significantly after treatment with pancrelipase (53.3% vs. 20.0%; p < 0.05). Conclusions: The results suggested that pancrelipase might improve hepatic steatosis after pancreaticoduodenectomy.