Pancreatic exocrine insufficiency after esophageal and gastric surgery: the PEGAS study

INTRODUCTION: Pancreatic exocrine insufficiency (PEI) is a potential but under-recognized complication after upper gastrointestinal (GI) surgery, contributing to malabsorption and nonspecific GI symptoms. AIMS AND METHODS: This prospective cohort study included adult patients undergoing esophagectomy or gastrectomy at a single tertiary referral center between March 2022 and January 2024. A total of 51 patients were included, with 34 completing full follow-up. The primary outcome was the prevalence of PEI. A secondary outcome was the effect of pancreatic enzyme replacement therapy (PERT) in patients with PEI. RESULTS: Among 31 patients undergoing esophagectomy, one (3.2%) was diagnosed with PEI. In contrast, PEI was identified in five (25.0%) of 20 patients after total or subtotal gastrectomy. PERT was administered in all patients with PEI. At 12-months' follow-up, clinical improvement in PEI symptoms was observed in four of six patients, while in two patients, disease progression due to cancer prevented assessment of the PERT effect. CONCLUSIONS: PEI is a clinically significant postoperative complication after upper GI surgery. These findings support the inclusion of pancreatic exocrine function assessment in the postoperative follow-up of gastric surgery patients, particularly those presenting with nonspecific GI symptoms and malabsorption, to enable timely diagnosis and management.