OGC P22 The Prevalence of Malabsorption and Use of Pancreatic Enzyme Replacement Therapy Post Upper GI Surgery

Abstract

Abstract Background Pancreatic enzyme insuffiency (PEI) appears to be under recognised and under treated in upper GI surgery due to limited evidence regarding the prevalence of PEI post operatively. This has potential to exacerbate the risk of malnutrition in an already vulnerable patient group. Pancreatic enzyme replacement therapy (PERT) may influence nutritional status and quality of life after Upper GI surgery, but the research to date remains controversial. A retrospective audit was carried out to review the use of PERT in 233 Upper GI surgeries across a two-year period. Methods Retrospective audit documenting all patients that have undergone a GIST resection, distal gastrectomy, subtotal gastrectomy, completion gastrectomy, oesophagectomy and total gastrectomy between 2021-2022 at a tertiary centre for Upper GI cancer surgery. It was recorded from electronic patient records which of these patients were commenced on PERT post operatively. The time frame in which the PERT was initiated was captured, as well as and what dose patients required to provide symptom relief. The duration of PERT prescription was recorded in addition to patients’ tolerance. Results Initiation of PERT varied from one month to one year after surgery, with most patients (n=24) commencing PERT within the first month. The final dosage of PERT required varied between 50,000iu (n=36) and 125,000iu (n=6). Many patients remain on PERT (n=53); whilst 26% of individuals stopped PERT within six months due to no benefit found or poor tolerance (n=19). Conclusions The use of PERT in one third of surgical Upper GI patients highlights the prevalence of PEI in this patient group. This data indicates the initiation of PERT is higher within the first three months following surgery, with the majority of these patients’ requiring PERT for long term use. A larger, multicentre trial is needed to further analyse the benefits of PERT on weight and quality of life, whilst addressing the potential influence of confounding variables such as disease stage and adjuvant treatment.