title: Pancreatic exocrine insufficiency after pancreaticoduodenectomy is more prevalent with pancreaticogastrostomy than with pancreaticojejunostomy. A retrospective multicentre observational cohort study.
abstract: Recently, pancreaticogastrostomy (PG) has attracted renewed interest as a reconstruction technique after pancreaticoduodenectomy (PD), as it may imply a lower risk of clinical pancreatic fistula than reconstruction by pancreaticojejunostomy (PJ). We hypothesise that pancreatic exocrine insufficiency (PEI) is more common during clinical follow-up after PG than it is after PJ.
  
  
  
  This study compares the prevalence of PEI in patients undergoing PD for malignancy with reconstruction by PG versus reconstruction by PJ. PEI during the first year of follow-up was defined as the intake of pancreatic enzyme replacement therapy (PERT) within one year postoperatively and/or an abnormal exocrine function test.
  
  
  
  A total of 186 patients, having undergone surgery at two university hospitals, were included in the study. PEI during the first year postoperatively was present in 75.0% of the patients with PG, compared to 45.7% with PJ (p < 0.001). Intake of PERT within one year after surgery was found to be more prevalent in the PG group, i.e. 75.8% versus 38.5% (p < 0.001). There was a trend towards more disturbed exocrine function tests after PG (p = 0.061).
  
  
  
  PEI is more common with PG reconstruction than with PJ reconstruction after pancreaticoduodenectomy for malignancy.
authors.affiliation: Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Belgium; Faculty of Medicine, Antwerp University, Belgium. Electronic address: Geert.roeyen@uza.be.
authors.forename: Geert
authors.initials: G
authors.lastname: Roeyen
authors.affiliation: Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Belgium.
authors.forename: Miet
authors.initials: M
authors.lastname: Jansen
authors.affiliation: Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital, Belgium.
authors.forename: Laure
authors.initials: L
authors.lastname: Ruyssinck
authors.affiliation: Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Belgium; Faculty of Medicine, Antwerp University, Belgium.
authors.forename: Thiery
authors.initials: T
authors.lastname: Chapelle
authors.affiliation: Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital, Belgium.
authors.forename: Aude
authors.initials: A
authors.lastname: Vanlander
authors.affiliation: Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Belgium; Faculty of Medicine, Antwerp University, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Bracke
authors.affiliation: Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Belgium; Faculty of Medicine, Antwerp University, Belgium.
authors.forename: Vera
authors.initials: V
authors.lastname: Hartman
authors.affiliation: Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Belgium; Faculty of Medicine, Antwerp University, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Ysebaert
authors.affiliation: Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital, Belgium.
authors.forename: Frederik
authors.initials: F
authors.lastname: Berrevoet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D056947:Enzyme Replacement Therapy; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis / Q000188:drug therapy / Q000201:enzymology / Q000453:epidemiology*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010186:Pancreatic Function Tests; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D015995:Prevalence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome