It’s not uncommon for people who’ve undergone pancreatic surgery — to remove a tumor because of pancreatitis — to develop EPI afterward, according to a review published in April 2020 in World Journal of Gastrointestinal Pathophysiology. In some cases, EPI can be present even before a person has the surgery. Sometimes, surgeons must remove the entire pancreas, and other times they may only need to take a portion, says Timothy B. Gardner, MD, a professor of medicine at the Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire. If your pancreas is completely removed, you will develop EPI, a condition that occurs when your pancreas doesn’t make the digestive enzymes your body needs to function. But even partial removal can lead to EPI. “It’s a volume issue,” Dr. Gardner says. “The less pancreas you have, the less ability you have to make enzymes.” The odds of developing EPI as a result of surgery can also depend, in part, on the type of surgery you have and why you’re having it. The Whipple procedure, also known as a pancreaticoduodenectomy, is the most common surgery for pancreatic cancer, according to the Pancreatic Cancer Action Network. During a standard Whipple procedure, the surgeon removes the head of the pancreas and nearby lymph nodes as well as the gallbladder, part of the duodenum (the uppermost part of the small intestine), and a portion of the stomach called the pylorus. According to the World Journal of Gastrointestinal Pathophysiology review, EPI is “highly prevalent” after a Whipple procedure and can severely impact quality of life, nutrition, and survival rates. A different pancreatic surgery involves removing the bottom half (distal) or central neck of the pancreas, according to the American Cancer Society. This highly specialized surgery is offered at some centers to people with pancreatic tumors. The purpose of the surgery is to preserve pancreatic tissue and avoid complications such as diabetes and malabsorption of nutrients. According to an analysis published in October 2019 in the journal Therapeutics and Clinical Risk Management, the percentage of people who developed EPI after a distal pancreatectomy was 12 percent. A review published in January 2021 in the Journal of Gastrointestinal Surgery found EPI rates were approximately 5 percent among those who underwent a central pancreatectomy — the removal of the neck or body of the pancreas, which leaves the healthy head and tail of the organ intact.
Look for EPI Symptoms
If your pancreas has been removed, EPI isn’t preventable, Gardner says. If some of your pancreas remains and it’s not certain you’ll develop the condition, it’s important to look for signs of EPI, Gardner advises. Fecal tests, blood tests, computed tomography (CT) scans, and ultrasounds can be done to determine if you’ve developed EPI, but your doctor may also suspect it based on your symptoms. These may include:
Stomach pain and tendernessWeight lossFeeling fullHaving no appetiteSteatorrhea (fatty stool)Bone painMuscle cramps
Postsurgical EPI Can Be Treated
If you develop EPI, it can be treated with pancreatic enzyme replacement therapy (PERT) — capsules that contain replacement digestive enzymes, according to the National Pancreas Foundation. “PERT effectively treats EPI,” Gardner says. Dosing is individualized, he adds, and determined by the content of your meals. People who develop EPI may also need to make some lifestyle changes, such as eating a healthy, nutrient-rich diet and taking vitamins and other supplements, according to the National Pancreas Foundation. Bottom line: EPI can develop or worsen after pancreatic surgery, but you can work closely with your doctor to find the best treatment and lifestyle strategies for you.
