Exocrine pancreatic insufficiency in adults: A shared position statement of the Italian association for the study of the pancreas

World Journal of Gastroenterology

Volumn 19, Issue 44, 2013, Pages 7930-7946

  Pezzilli, Raffaele ^a   Andriulli, Angelo ^a   Bassi, Claudio ^a   Balzano, Gianpaolo ^a   Cantore, Maurizio ^a   Delle Fave, Gianfranco ^a   Falconi, Massimo ^a   Frulloni, Luca ^a  

^a UNIVERSITY OF BOLOGNA   (Italy)

Author keywords

Chronic pancreatitis; Clinical studies; Exocrine pancreatic insufficiency; Gastric surgery; Pancreatic neoplasms; Pancreatic surgery; Risk factors

Indexed keywords

BENTIROMIDE; CHYMOTRYPSIN; PANCREAS ENZYME; PANCREAS EXTRACT; PANCREATIC ELASTASE; PROTON PUMP INHIBITOR; TRIACYLGLYCEROL LIPASE; XYLOSE;

ACUTE PANCREATITIS; CELIAC DISEASE; CHRONIC PANCREATITIS; CROHN DISEASE; DIABETES MELLITUS; DIAGNOSTIC TEST ACCURACY STUDY; DIGESTION; DIGESTIVE SYSTEM FUNCTION DISORDER; DRUG DOSE INCREASE; DRUG MEGADOSE; ENUCLEATION; ENZYME REPLACEMENT; FAT INTAKE; FECES ANALYSIS; FOOD INTAKE; HUMAN; NUTRITIONAL STATUS; PANCREAS ADENOCARCINOMA; PANCREAS EXOCRINE INSUFFICIENCY; PANCREAS RESECTION; PANCREATICODUODENECTOMY; RECOMMENDED DRUG DOSE; REVIEW; STEATORRHEA; STOMACH SURGERY; TOTAL STOMACH RESECTION; TREATMENT FAILURE; ULCERATIVE COLITIS; WEIGHT GAIN;

CHRONIC PANCREATITIS; CLINICAL STUDIES; EXOCRINE PANCREATIC INSUFFICIENCY; GASTRIC SURGERY; PANCREATIC NEOPLASMS; PANCREATIC SURGERY; RISK FACTORS;

ADULT; AGE FACTORS; ALGORITHMS; CRITICAL PATHWAYS; ENDOCRINOLOGY; ENZYME REPLACEMENT THERAPY; EXOCRINE PANCREATIC INSUFFICIENCY; GASTROINTESTINAL AGENTS; HUMANS; NUTRITION THERAPY; PANCREATIC FUNCTION TESTS; PREDICTIVE VALUE OF TESTS; RISK FACTORS; SOCIETIES, MEDICAL; TREATMENT OUTCOME;

EID: 84888598147     PISSN: 10079327     EISSN: 22192840     Source Type: Journal    
DOI: 10.3748/wjg.v19.i44.7930     Document Type: Review

References (155)

1. Gullo L, Pezzilli R, Priori P, Baldoni F, Paparo F, Mattioli G. Pure pancreatic juice collection over 24 consecutive hours. Pancreas 1987; 2: 620-623 [PMID: 3671350 DOI: 10.1097/0000 6676-198709000-00020]
2. Scheele G, Bartelt D, Bieger W. Characterization of human exocrine pancreatic proteins by two-dimensional isoelectric focusing/sodium dodecyl sulfate gel electrophoresis. Gastroenterology 1981; 80: 461-473 [PMID: 6969677]
3. Borgstrom B, Dahlqvist A, Lundh G, Sjovall J. Studies of intestinal digestion and absorption in the human. J Clin Invest 1957; 36: 1521-1536 [PMID: 13475490 DOI: 10.1172/ JCI103549]
4. Layer P, Go VL, DiMagno EP. Fate of pancreatic enzymes during small intestinal aboral transit in humans. Am J Physiol 1986; 251: G475-G480 [PMID: 2429560]
5. Granger M, Abadie B, Marchis-Mouren G. Limited action of trypsin on porcine pancreatic amylase: characterization of the fragments. FEBS Lett 1975; 56: 189-193 [PMID: 1157938 DOI: 10.1016/0014-5793(75)81088-X]
6. Layer P, Jansen JB, Cherian L, Lamers CB, Goebell H. Feedback regulation of human pancreatic secretion. Effects of protease inhibition on duodenal delivery and small intestinal transit of pancreatic enzymes. Gastroenterology 1990; 98: 1311-1319 [PMID: 2323522]
7. Holtmann G, Kelly DG, Sternby B, DiMagno EP. Survival of human pancreatic enzymes during small bowel transit: effect of nutrients, bile acids, and enzymes. Am J Physiol 1997; 273: G553-G558 [PMID: 9277437]
8. Black DD. Development and physiological regulation of intestinal lipid absorption. I. Development of intestinal lipid absorption: cellular events in chylomicron assembly and secretion. Am J Physiol Gastrointest Liver Physiol 2007; 293: G519-G524 [PMID: 17495031 DOI: 10.1152/ajpgi.00189.2007]
9. Frulloni L, Falconi M, Gabbrielli A, Gaia E, Graziani R, Pezzilli R, Uomo G, Andriulli A, Balzano G, Benini L, Calculli L, Campra D, Capurso G, Cavestro GM, De Angelis C, Ghezzo L, Manfredi R, Malesci A, Mariani A, Mutignani M, Ventrucci M, Zamboni G, Amodio A, Vantini I, Bassi C, Delle Fave G, Frulloni L, Vantini I, Falconi M, Frulloni L, Gabbrielli A, Graziani R, Pezzilli R, Capurso IV, Cavestro GM, De Angelis C, Falconi M, Gaia E, Ghezzo L, Gabbrielli A, Graziani R, Manfredi R, Malesci A, Mariani A, Mutignani M, Pezzilli R, Uomo G, Ventrucci M, Zamboni G, Vantini I, Magarini F, Albarello L, Alfieri S, Amodio A, Andriulli A, Anti M, Arcidiacono P, Baiocchi L, Balzano G, Benini L, Berretti D, Boraschi P, Buscarini E, Calculli L, Carroccio A, Campra D, Celebrano MR, Capurso G, Casadei R, Cavestro GM, Chilovi F, Conigliaro R, Dall'Oglio L, De Angelis C, De Boni M, De Pretis G, Di Priolo S, Di Sebastiano PL, Doglietto GB, Falconi M, Filauro M, Frieri G, Frulloni L, Fuini A, Gaia E, Ghezzo L, Gabbrielli A, Graziani R, Loriga P, Macarri G, Manes G, Manfredi R, Malesci A, Mariani A, Massucco P, Milani S, Mutignani M, Pasquali C, Pederzoli P, Pezzilli R, Pietrangeli M, Rocca R, Russello D, Siquini W, Traina M, Uomo G, Veneroni L, Ventrucci M, Zilli M, Zamboni G. Italian consensus guidelines for chronic pancreatitis. Dig Liver Dis 2010; 42 Suppl 6: S381-S406 [PMID: 21078490 DOI: 10.1016/S1590-8658(10)60682-2]
10. DiMagno EP, Go VL, Summerskill WH. Relations between pancreatic enzyme ouputs and malabsorption in severe pancreatic insufficiency. N Engl J Med 1973; 288: 813-815 [PMID: 4693931 DOI: 10.1056/NEJM197304192881603]
11. Gullo L, Costa PL, Fontana G, Labò G. Investigation of exocrine pancreatic function by continuous infusion of caerulein and secretin in normal subjects and in chronic pancreatitis. Digestion 1976; 14: 97-107 [PMID: 950084 DOI: 10.1159/000197914]
12. Gullo L, Ventrucci M, Tomassetti P, Migliori M, Pezzilli R. Fecal elastase 1 determination in chronic pancreatitis. Dig Dis Sci 1999; 44: 210-213 [PMID: 9952246]
13. Pezzilli R, Morselli-Labate AM, Palladoro F, Campana D, Piscitelli L, Tomassetti P, Corinaldesi R. The ELISA fecal elastase-1 polyclonal assay reacts with different antigens than those of the monoclonal assay. Pancreas 2005; 31: 200-201 [PMID: 16025011 DOI: 10.1097/01.mpa.0000167002.96641.70]
14. Leodolter A, Kahl S, Domínguez-Muñoz JE, Gerards C, Glasbrenner B, Malfertheiner P. Comparison of two tubeless function tests in the assessment of mild-to-moderate exocrine pancreatic insufficiency. Eur J Gastroenterol Hepatol 2000; 12: 1335-1338 [PMID: 11192324 DOI: 10.1097/00042737-200012120-00012]
15. Ventrucci M, Cipolla A, Ubalducci GM, Roda A, Roda E. 13C labelled cholesteryl octanoate breath test for assessing pancreatic exocrine insufficiency. Gut 1998; 42: 81-87 [PMID: 9505890 DOI: 10.1136/gut.42.1.81]
16. Ventrucci M, Gullo L, Daniele C, Priori P, Labò G. Pancreolauryl test for pancreatic exocrine insufficiency. Am J Gastroenterol 1983; 78: 806-809 [PMID: 6606355]
17. Drummey GD, Benson JA, Jones CM. Microscopical examination of the stool for steatorrhea. N Engl J Med 1961; 264: 85-87 [PMID: 13724507 DOI: 10.1056/NEJM196101122640207]
18. Fine KD, Ogunji F. A new method of quantitative fecal fat microscopy and its correlation with chemically measured fecal fat output. Am J Clin Pathol 2000; 113: 528-534 [PMID: 10761454 DOI: 10.1309/0T2W-NN7F-7T8Q-5N8C]
19. Sugai E, Srur G, Vazquez H, Benito F, Mauriño E, Boerr LA, Bai JC. Steatocrit: a reliable semiquantitative method for detection of steatorrhea. J Clin Gastroenterol 1994; 19: 206-209 [PMID: 7806830 DOI: 10.1097/00004836-199410000-00007]
20. Amann ST, Josephson SA, Toskes PP. Acid steatocrit: a simple, rapid gravimetric method to determine steatorrhea. Am J Gastroenterol 1997; 92: 2280-2284 [PMID: 9399770]
21. Gullo L, Pezzilli R, Cassano A, Ligabue A, Ventrucci M,. Barbara L. Clinical effectiveness of a new enteric-coated pancreatic enzyme extract in the treatment of pancreatic steatorrhoea. Curr Ther Res 1988; 44: 105-109
22. Seiler CM, Izbicki J, Varga-Szabó L, Czakó L, Fiók J, Sperti C, Lerch MM, Pezzilli R, Vasileva G, Pap A, Varga M, Friess H. Randomised clinical trial: a 1-week, double-blind, placebocontrolled study of pancreatin 25000Ph. Eur. minimicrospheres (Creon 25000 MMS) for pancreatic exocrine insufficiency after pancreatic surgery, with a 1-year open-label extension. Aliment Pharmacol Ther 2013; 37: 691-702 [PMID: 23383603 DOI: 10.1111/apt.12236]
23. Borowitz D, Konstan MW, O'Rourke A, Cohen M, Hendeles L, Murray FT. Coefficients of fat and nitrogen absorption in healthy subjects and individuals with cystic fibrosis. J Pediatr Pharmacol Ther 2007; 12: 47-52 [PMID: 23055842]
24. Lindkvist B, Domínguez-Muñoz JE, Luaces-Regueira M, Castiñeiras-Alvariño M, Nieto-Garcia L, Iglesias-Garcia J. Serum nutritional markers for prediction of pancreatic exocrine insufficiency in chronic pancreatitis. Pancreatology 2012; 12: 305-310 [PMID: 22898630 DOI: 10.1016/j.pan.2012.04.006]
25. Talukdar R, Reddy DN. Rational use of pancreatic enzymes in patients with chronic pancreatitis. Pancreatology 2012; 12: 480-481; author reply 480-481 [PMID: 23217282 DOI: 10.1016/j.pan.2012.09.003]
26. Gupta D, Lis CG, Dahlk SL, Vashi PG, Grutsch JF, Lammersfeld CA. Bioelectrical impedance phase angle as a prognostic indicator in advanced pancreatic cancer. Br J Nutr 2004; 92: 957-962 [PMID: 15613258 DOI: 10.1079/BJN20041292]
27. Layer P, Keller J, Lankisch PG. Pancreatic enzyme replacement therapy. Curr Gastroenterol Rep 2001; 3: 101-108 [PMID: 11276376 DOI: 10.1007/s11894-001-0005-8]
28. Domínguez-Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep 2007; 9: 116-122 [PMID: 17418056 DOI: 10.1007/s11894-007-0005-4]
29. Caliari S, Benini L, Sembenini C, Gregori B, Carnielli V, Vantini I. Medium-chain triglyceride absorption in patients with pancreatic insufficiency. Scand J Gastroenterol 1996; 31: 90-94 [PMID: 8927947 DOI: 10.3109/00365529609031633]
30. Isaksson G, Lilja P, Lundquist I, Ihse I. Influence of dietary fiber on exocrine pancreatic function in the rat. Digestion 1983; 27: 57-62 [PMID: 6195035 DOI: 10.1159/000198930]
31. de-Madaria E, Abad-González A, Aparicio JR, Aparisi L, Boadas J, Boix E, de-Las-Heras G, Domínguez-Muñoz E, Farré A, Fernández-Cruz L, Gómez L, Iglesias-García J, GarcíaMalpartida K, Guarner L, Lariño-Noia J, Lluís F, López A, Molero X, Moreno-Pérez O, Navarro S, Palazón JM, PérezMateo M, Sabater L, Sastre Y, Vaquero EC, Martínez J. The Spanish Pancreatic Club's recommendations for the diagnosis and treatment of chronic pancreatitis: part 2 (treatment). Pancreatology 2013; 13: 18-28 [PMID: 23395565 DOI: 10.1016/ j.pan.2012.11.310]
32. Singh S, Midha S, Singh N, Joshi YK, Garg PK. Dietary counseling versus dietary supplements for malnutrition in chronic pancreatitis: a randomized controlled trial. Clin Gastroenterol Hepatol 2008; 6: 353-359 [PMID: 18328440 DOI: 10.1016/j.cgh.2007.12.040]
33. Caliari S, Benini L, Bonfante F, Brentegani MT, Fioretta A, Vantini I. Pancreatic extracts are necessary for the absorption of elemental and polymeric enteral diets in severe pancreatic insufficiency. Scand J Gastroenterol 1993; 28: 749-752 [PMID: 8210993 DOI: 10.3109/00365529309098285]
34. Dutta SK, Hlasko J. Dietary fiber in pancreatic disease: effect of high fiber diet on fat malabsorption in pancreatic insufficiency and in vitro study of the interaction of dietary fiber with pancreatic enzymes. Am J Clin Nutr 1985; 41: 517-525 [PMID: 2579539]
35. Guarner L, Rodríguez R, Guarner F, Malagelada JR. Fate of oral enzymes in pancreatic insufficiency. Gut 1993; 34: 708-712 [PMID: 8504976 DOI: 10.1136/gut.34.5.708]
36. Sarner M. Treatment of pancreatic exocrine deficiency. World J Surg 2003; 27: 1192-1195 [PMID: 14534818 DOI: 10.1007/ s00268-003-7237-8]
37. Pezzilli R. Chronic pancreatitis: maldigestion, intestinal ecology and intestinal inflammation. World J Gastroenterol 2009; 15: 1673-1676 [PMID: 19360910 DOI: 10.3748/wjg.15.1673]
38. Toouli J, Biankin AV, Oliver MR, Pearce CB, Wilson JS, Wray NH. Management of pancreatic exocrine insufficiency: Australasian Pancreatic Club recommendations. Med J Aust 2010; 193: 461-467 [PMID: 20955123]
39. Domínguez-Muñoz JE, Iglesias-García J. Oral pancreatic enzyme substitution therapy in chronic pancreatitis: is clinical response an appropriate marker for evaluation of therapeutic efficacy? JOP 2010; 11: 158-162 [PMID: 20208327]
40. Sack J, Blau H, Goldfarb D, Ben-Zaray S, Katznelson D. Hyperuricosuria in cystic fibrosis patients treated with pancreatic enzyme supplements. A study of 16 patients in Israel. Isr J Med Sci 1980; 16: 417-419 [PMID: 6901713]
41. FitzSimmons SC, Burkhart GA, Borowitz D, Grand RJ, Hammerstrom T, Durie PR, Lloyd-Still JD, Lowenfels AB. High-dose pancreatic-enzyme supplements and fibrosing colonopathy in children with cystic fibrosis. N Engl J Med 1997; 336: 1283-1289 [PMID: 9113931 DOI: 10.1056/ NEJM199705013361803]
42. Gullo L, Pezzilli R, Gaiani S. Tolerability and safety of the long-term administration of pancreatic extracts. Pancreas 1997; 14: 210-212 [PMID: 9057197 DOI: 10.1097/00006676-199 703000-00018]
43. Pezzilli R, Uomo G, Zerbi A, Gabbrielli A, Frulloni L, De Rai P, Delle Fave G, Di Carlo V. Diagnosis and treatment of acute pancreatitis: the position statement of the Italian Association for the study of the pancreas. Dig Liver Dis 2008; 40: 803-808 [PMID: 18387862 DOI: 10.1016/j.dld.2008.02.019]
44. Uomo G, Pezzilli R, Gabbrielli A, Castoldi L, Zerbi A, Frulloni L, De Rai P, Cavallini G, Di Carlo V. Diagnostic assessment and outcome of acute pancreatitis in Italy: results of a prospective multicentre study. ProInf-AISP: Progetto informatizzato pancreatite acuta, Associazione Italiana Studio Pancreas, phase II. Dig Liver Dis 2007; 39: 829-837 [PMID: 17625994 DOI: 10.1016/j.dld.2007.05.009]
45. Pezzilli R, Simoni P, Casadei R, Morselli-Labate AM. Exocrine pancreatic function during the early recovery phase of acute pancreatitis. Hepatobiliary Pancreat Dis Int 2009; 8: 316-319 [PMID: 19502175]
46. Bruno MJ, Haverkort EB, Tytgat GN, van Leeuwen DJ. Maldigestion associated with exocrine pancreatic insufficiency: implications of gastrointestinal physiology and properties of enzyme preparations for a cause-related and patient-tailored treatment. Am J Gastroenterol 1995; 90: 1383-1393 [PMID: 7661155]
47. Domínguez-Muñoz JE, Iglesias-García J, Vilariño-Insua M, Iglesias-Rey M. 13C-mixed triglyceride breath test to assess oral enzyme substitution therapy in patients with chronic pancreatitis. Clin Gastroenterol Hepatol 2007; 5: 484-488 [PMID: 17445754 DOI: 10.1016/j.cgh.2007.01.004]
48. Hoffmeister A, Mayerle J, Beglinger C, Büchler MW, Bufler P, Dathe K, Fölsch UR, Friess H, Izbicki J, Kahl S, Klar E, Keller J, Knoefel WT, Layer P, Loehr M, Meier R, Riemann JF, Rünzi M, Schmid RM, Schreyer A, Tribl B, Werner J, Witt H, Mössner J, Lerch MM. [S3-Consensus guidelines on definition, etiology, diagnosis and medical, endoscopic and surgical management of chronic pancreatitis German Society of Digestive and Metabolic Diseases (DGVS)]. Z Gastroenterol 2012; 50: 1176-1224 [PMID: 23150111 DOI: 10.1055/s-0032-1325479]
49. Meier R, Ockenga J, Pertkiewicz M, Pap A, Milinic N, Macfie J, Löser C, Keim V. ESPEN Guidelines on Enteral Nutrition: Pancreas. Clin Nutr 2006; 25: 275-284 [PMID: 16678943 DOI: 10.1016/j.clnu.2006.01.019]
50. Gullo L, Barbara L, Labò G. Effect of cessation of alcohol use on the course of pancreatic dysfunction in alcoholic pancreatitis. Gastroenterology 1988; 95: 1063-1068 [PMID: 3410221]
51. Lohr JM, Oliver MR, Frulloni L. Synopsis of recent guidelines on pancreatic exocrine insufficiency. United Eur Gastroenterol J 2013; In press [DOI: 10.1177/2050640613476500]
52. DiMagno EP. Gastric acid suppression and treatment of severe exocrine pancreatic insufficiency. Best Pract Res Clin Gastroenterol 2001; 15: 477-486 [PMID: 11403540 DOI: 10.1053/bega.2001.0195]
53. Domínguez-Muñoz JE, Iglesias-García J, Iglesias-Rey M, Vilariño-Insua M. Optimising the therapy of exocrine pancreatic insufficiency by the association of a proton pump inhibitor to enteric coated pancreatic extracts. Gut 2006; 55: 1056-1057 [PMID: 16766768 DOI: 10.1136/gut.2006.094912]
54. Graham DY, Sackman JW. Mechanism of increase in steatorrhea with calcium and magnesium in exocrine pancreatic insufficiency: an animal model. Gastroenterology 1982; 83: 638-644 [PMID: 7095367]
55. Lankisch PG. What to do when a patient with exocrine pancreatic insufficiency does not respond to pancreatic enzyme substitution, a practical guide. Digestion 1999; 60 Suppl 1: 97-103 [PMID: 10026441 DOI: 10.1159/000051463]
56. Domínguez-Muñoz JE, Iglesias-García J, Iglesias-Rey M, Figueiras A, Vilariño-Insua M. Effect of the administration schedule on the therapeutic efficacy of oral pancreatic enzyme supplements in patients with exocrine pancreatic insufficiency: a randomized, three-way crossover study. Aliment Pharmacol Ther 2005; 21: 993-1000 [PMID: 15813835 DOI: 10.1111/j.1365-2036.2005.02390.x]
57. Casellas F, Guarner L, Vaquero E, Antolín M, de Gracia X, Malagelada JR. Hydrogen breath test with glucose in exocrine pancreatic insufficiency. Pancreas 1998; 16: 481-486 [PMID: 9598808 DOI: 10.1097/00006676-199805000-00004]
58. Pieramico O, Dominguez-Muñoz JE, Nelson DK, Böck W, Büchler M, Malfertheiner P. Interdigestive cycling in chronic pancreatitis: altered coordination among pancreatic secretion, motility, and hormones. Gastroenterology 1995; 109: 224-230 [PMID: 7540998 DOI: 10.1016/0016-5085(95)90288-0]
59. Vincent A, Herman J, Schulick R, Hruban RH, Goggins M. Pancreatic cancer. Lancet 2011; 378: 607-620 [PMID: 21620466 DOI: 10.1016/S0140-6736(10)62307-0]
60. el-Kamar FG, Grossbard ML, Kozuch PS. Metastatic pancreatic cancer: emerging strategies in chemotherapy and palliative care. Oncologist 2003; 8: 18-34 [PMID: 12604729 DOI: 10.1634/theoncologist.8-1-18]
61. Perez MM, Newcomer AD, Moertel CG, Go VL, Dimagno EP. Assessment of weight loss, food intake, fat metabolism, malabsorption, and treatment of pancreatic insufficiency in pancreatic cancer. Cancer 1983; 52: 346-352 [PMID: 6305473 DOI: 10.1002/1097-0142(19830715)52:]
62. Yuasa Y, Murakami Y, Nakamura H, Uemura K, Ohge H, Sudo T, Hashimoto Y, Nakashima A, Hiyama E, Sueda T. Histological loss of pancreatic exocrine cells correlates with pancreatic exocrine function after pancreatic surgery. Pancreas 2012; 41: 928-933 [PMID: 22781909 DOI: 10.1097/ MPA.0b013e31823d837d]
63. Halloran CM, Cox TF, Chauhan S, Raraty MG, Sutton R, Neoptolemos JP, Ghaneh P. Partial pancreatic resection for pancreatic malignancy is associated with sustained pancreatic exocrine failure and reduced quality of life: a prospective study. Pancreatology 2011; 11: 535-545 [PMID: 22094930 DOI: 10.1159/000333308]
64. DiMagno EP, Malagelada JR, Go VL. The relationships between pancreatic ductal obstruction and pancreatic secretion in man. Mayo Clin Proc 1979; 54: 157-162 [PMID: 431121]
65. Weber A, Kehl V, Mittermeyer T, Herberich E, Röthling N, Schmid RM, Prinz C. Prognostic factors for survival in patients with unresectable pancreatic cancer. Pancreas 2010; 39: 1247-1253 [PMID: 20683218 DOI: 10.1097/ MPA.0b013e3181e21b1b]
66. Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, Cohen MH, Douglass HO, Engstrom PF, Ezdinli EZ, Horton J, Johnson GJ, Moertel CG, Oken MM, Perlia C, Rosenbaum C, Silverstein MN, Skeel RT, Sponzo RW, Tormey DC. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 1980; 69: 491-497 [PMID: 7424938 DOI: 10.1016/ S0149-2918(05)80001-3]
67. Papadoniou N, Kosmas C, Gennatas K, Polyzos A, Mouratidou D, Skopelitis E, Tzivras M, Sougioultzis S, Papastratis G, Karatzas G, Papalambros E, Tsavaris N. Prognostic factors in patients with locally advanced (unresectable) or metastatic pancreatic adenocarcinoma: a retrospective analysis. Anticancer Res 2008; 28: 543-549 [PMID: 18383900]
68. Partelli S, Frulloni L, Minniti C, Bassi C, Barugola G, D'Onofrio M, Crippa S, Falconi M. Faecal elastase-1 is an independent predictor of survival in advanced pancreatic cancer. Dig Liver Dis 2012; 44: 945-951 [PMID: 22749648 DOI: 10.1016/ j.dld.2012.05.017]
69. Bruno MJ, Haverkort EB, Tijssen GP, Tytgat GN, van Leeuwen DJ. Placebo controlled trial of enteric coated pancreatin microsphere treatment in patients with unresectable cancer of the pancreatic head region. Gut 1998; 42: 92-96 [PMID: 9505892 DOI: 10.1136/gut.42.1.92]
70. Pelzer U, Arnold D, Gövercin M, Stieler J, Doerken B, Riess H, Oettle H. Parenteral nutrition support for patients with pancreatic cancer. Results of a phase II study. BMC Cancer 2010; 10: 86 [PMID: 20214798 DOI: 10.1186/1471-2407-10-86]
71. Richter E, Denecke A, Klapdor S, Klapdor R. Parenteral nutrition support for patients with pancreatic cancer--improvement of the nutritional status and the therapeutic outcome. Anticancer Res 2012; 32: 2111-2118 [PMID: 22593497]
72. Chey WY, Shay H, Shuman CR. External pancreatic secretion in diabetes mellitus. Ann Intern Med 1963; 59: 812-821 [PMID: 14082733 DOI: 10.7326/0003-4819-59-6-812]
73. El Newihi H, Dooley CP, Saad C, Staples J, Zeidler A, Valenzuela JE. Impaired exocrine pancreatic function in diabetics with diarrhea and peripheral neuropathy. Dig Dis Sci 1988; 33: 705-710 [PMID: 2897272 DOI: 10.1007/BF01540434]
74. Frier BM, Saunders JH, Wormsley KG, Bouchier IA. Exocrine pancreatic function in juvenile-onset diabetes mellitus. Gut 1976; 17: 685-691 [PMID: 976808 DOI: 10.1136/gut.17.9.685]
75. Gröger G, Layer P. Exocrine pancreatic function in diabetes mellitus. Eur J Gastroenterol Hepatol 1995; 7: 740-746 [PMID: 7496861]
76. Harano Y, Kim CI, Kang M, Shichiri M, Shimizu Y, Li H, Yoshida M, Shigeta Y, Abe H. External pancreatic dysfunction associated with diabetes mellitus. J Lab Clin Med 1978; 91: 780-790 [PMID: 641400]
77. Lankisch PG, Manthey G, Otto J, Koop H, Talaulicar M, Willms B, Creutzfeldt W. Exocrine pancreatic function in insulin-dependent diabetes mellitus. Digestion 1982; 25: 211-216 [PMID: 6186557 DOI: 10.1159/000198833]
78. Vacca JB, Henke WJ, Knight WA. The exocrine pancreas in diabetes mellitus. Ann Intern Med 1964; 61: 242-247 [PMID: 14204860 DOI: 10.7326/0003-4819-61-2-242]
79. Hardt PD, Krauss A, Bretz L, Porsch-Ozcürümez M, SchnellKretschmer H, Mäser E, Bretzel RG, Zekhorn T, Klör HU. Pancreatic exocrine function in patients with type 1 and type 2 diabetes mellitus. Acta Diabetol 2000; 37: 105-110 [PMID: 11277309 DOI: 10.1007/s005920070011]
80. Hardt PD, Hauenschild A, Nalop J, Marzeion AM, Jaeger C, Teichmann J, Bretzel RG, Hollenhorst M, Kloer HU. High prevalence of exocrine pancreatic insufficiency in diabetes mellitus. A multicenter study screening fecal elastase 1 concentrations in 1,021 diabetic patients. Pancreatology 2003; 3: 395-402 [PMID: 14526149 DOI: 10.1159/000073655]
81. Vesterhus M, Raeder H, Aurlien H, Gjesdal CG, Bredrup C, Holm PI, Molven A, Bindoff L, Berstad A, Njølstad PR. Neurological features and enzyme therapy in patients with endocrine and exocrine pancreas dysfunction due to CEL mutations. Diabetes Care 2008; 31: 1738-1740 [PMID: 18544793 DOI: 10.2337/dc07-2217]
82. Larger E, Philippe MF, Barbot-Trystram L, Radu A, Rotariu M, Nobécourt E, Boitard C. Pancreatic exocrine function in patients with diabetes. Diabet Med 2012; 29: 1047-1054 [PMID: 22273174 DOI: 10.1111/j.1464-5491.2012.03597.x]
83. Icks A, Haastert B, Giani G, Rathmann W. Low fecal elastase-1 in type I diabetes mellitus. Z Gastroenterol 2001; 39: 823-830 [PMID: 11605150 DOI: 10.1055/s-2001-17867]
84. Cavalot F, Bonomo K, Perna P, Bacillo E, Salacone P, Gallo M, Mattiello L, Trovati M, Gaia E. Pancreatic elastase-1 in stools, a marker of exocrine pancreas function, correlates with both residual beta-cell secretion and metabolic control in type 1 diabetic subjects. Diabetes Care 2004; 27: 2052-2054 [PMID: 15277440 DOI: 10.2337/diacare.27.8.2052]
85. Rathmann W, Haastert B, Icks A, Giani G, Hennings S, Mitchell J, Curran S, Wareham NJ. Low faecal elastase 1 concentrations in type 2 diabetes mellitus. Scand J Gastroenterol 2001; 36: 1056-1061 [PMID: 11589378 DOI: 10.1080/00365520 1750422657]
86. Nunes AC, Pontes JM, Rosa A, Gomes L, Carvalheiro M, Freitas D. Screening for pancreatic exocrine insufficiency in patients with diabetes mellitus. Am J Gastroenterol 2003; 98: 2672-2675 [PMID: 14687815 DOI: 10.1111/j.1572-0241.2003.08730.x]
87. Yilmaztepe A, Ulukaya E, Ersoy C, Yilmaz M, Tokullugil HA. Investigation of fecal pancreatic elastase-1 levels in type 2 diabetic patients. Turk J Gastroenterol 2005; 16: 75-80 [PMID: 16252196]
88. Talley NJ, Young L, Bytzer P, Hammer J, Leemon M, Jones M, Horowitz M. Impact of chronic gastrointestinal symptoms in diabetes mellitus on health-related quality of life. Am J Gastroenterol 2001; 96: 71-76 [PMID: 11197290 DOI: 10.1111/ j.1572-0241.2001.03350.x]
89. Hardt PD, Hauenschild A, Jaeger C, Teichmann J, Bretzel RG, Kloer HU. High prevalence of steatorrhea in 101 diabetic patients likely to suffer from exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations: a prospective multicenter study. Dig Dis Sci 2003; 48: 1688-1692 [PMID: 14560984]
90. Cavalot F, Bonomo K, Fiora E, Bacillo E, Salacone P, Chirio M, Gaia E, Trovati M. Does pancreatic elastase-1 in stools predict steatorrhea in type 1 diabetes? Diabetes Care 2006; 29: 719-721 [PMID: 16505538 DOI: 10.2337/diacare.29.03.06. dc05-1389]
91. Hardt PD. Comment on "Lw fecal elastase 1 levels do not indicate exocrine pancreatic insufficiency in type-1 diabetes mellitus (pancreas. 2008; 36: 274-278)". Pancreas 2009; 38: 471-42; author reply 471-42; [PMID: 19390407 DOI: 10.1097/ MPA.0b013e31818b0060]
92. Ewald N, Bretzel RG, Fantus IG, Hollenhorst M, Kloer HU, Hardt PD. Pancreatin therapy in patients with insulin-treated diabetes mellitus and exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations. Results of a prospective multi-centre trial. Diabetes Metab Res Rev 2007; 23: 386-391 [PMID: 17103488 DOI: 10.1002/dmrr.708]
93. Teichmann J, Mann ST, Stracke H, Lange U, Hardt PD, Bretzel RG, Klör HU. Parathormone levels and Vitamin D metabolism in female patients with various grades of fecal elastase 1 deficiency. Eur J Med Res 2008; 13: 563-567 [PMID: 19073396]
94. Glasbrenner B, Malfertheiner P, Kerner W, Scherbaum WA, Ditschuneit H. Effect of pancreatin on diabetes mellitus in chronic pancreatitis. Z Gastroenterol 1990; 28: 275-279 [PMID: 2238755]
95. Mohan V, Poongothai S, Pitchumoni CS. Oral pancreatic enzyme therapy in the control of diabetes mellitus in tropical calculous pancreatitis. Int J Pancreatol 1998; 24: 19-22 [PMID: 9746885]
96. Weitgasser R, Abrahamian H, Clodi M, Fortunat W, Hammer H. [Position paper: Exocrine pancreatic insufficiency and diabetes mellitus]. Wien Klin Wochenschr 2012; 124 Suppl 2: 100-103 [PMID: 23250472 DOI: 10.1007/s00508-012-0290-2]
97. West J, Logan RF, Hill PG, Lloyd A, Lewis S, Hubbard R, Reader R, Holmes GK, Khaw KT. Seroprevalence, correlates, and characteristics of undetected coeliac disease in England. Gut 2003; 52: 960-965 [PMID: 12801951 DOI: 10.1136/ gut.52.7.960]
98. Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 2003; 163: 286-292 [PMID: 12578508 DOI: 10.1001/archinte.163.3.286]
99. Green PH, Jabri B. Coeliac disease. Lancet 2003; 362: 383-391 [PMID: 12907013 DOI: 10.1016/S0140-6736(03)14027-5]
100. Green PH. The many faces of celiac disease: clinical presentation of celiac disease in the adult population. Gastroenterology 2005; 128: S74-S78 [PMID: 15825130 DOI: 10.1053/ j.gastro.2005.02.016]
101. Dreiling DA. The pancreatic secretion in the malabsorption syndrome and related malnutrition states. J Mt Sinai Hosp N Y 1957; 24: 243-250 [PMID: 13429322]
102. Regan PT, DiMagno EP. Exocrine pancreatic insufficiency in celiac sprue: a cause of treatment failure. Gastroenterology 1980; 78: 484-487 [PMID: 7351287]
103. Perri F, Pastore M, Festa V, Clemente R, Quitadamo M, D'Altilia MR, Niro G, Paolucci P, Andriulli A. Intraduodenal lipase activity in celiac disease assessed by means of 13C mixed-triglyceride breath test. J Pediatr Gastroenterol Nutr 1998; 27: 407-410 [PMID: 9779968 DOI: 10.1097/00005176-199 810000-00008]
104. Walkowiak J, Herzig KH. Fecal elastase-1 is decreased in villous atrophy regardless of the underlying disease. Eur J Clin Invest 2001; 31: 425-430 [PMID: 11380594 DOI: 10.1046/ j.1365-2362.2001.00822.x]
105. Carroccio A, Iacono G, Montalto G, Cavataio F, Lorello D, Soresi M, Di Martino D, Notarbartolo A. Pancreatic insufficiency in celiac disease is not dependent on nutritional status. Dig Dis Sci 1994; 39: 2235-2242 [PMID: 7924748 DOI: 10.1007/BF02090377]
106. Carroccio A, Iacono G, Montalto G, Cavataio F, Lorello D, Greco L, Soresi M, Notarbartolo A. Pancreatic enzyme therapy in childhood celiac disease. A double-blind prospective randomized study. Dig Dis Sci 1995; 40: 2555-2560 [PMID: 8536512 DOI: 10.1007/BF02220441]
107. Carroccio A, Iacono G, Montalto G, Cavataio F, Di Marco C, Balsamo V, Notarbartolo A. Exocrine pancreatic function in children with coeliac disease before and after a gluten free diet. Gut 1991; 32: 796-799 [PMID: 1855688 DOI: 10.1136/ gut.32.7.796]
108. Gomez JC, Morán CE, Mauriño EC, Bai JC. Exocrine pancreatic insufficiency in celiac disease. Gastroenterology 1998; 114: 621-623 [PMID: 9496962 DOI: 10.1016/ S0016-5085(98)70562-1]
109. Evans KE, Leeds JS, Morley S, Sanders DS. Pancreatic insufficiency in adult celiac disease: do patients require long-term enzyme supplementation? Dig Dis Sci 2010; 55: 2999-3004 [PMID: 20458623 DOI: 10.1007/s10620-010-1261-y]
110. Fine KD, Meyer RL, Lee EL. The prevalence and causes of chronic diarrhea in patients with celiac sprue treated with a gluten-free diet. Gastroenterology 1997; 112: 1830-1838 [PMID: 9178673 DOI: 10.1053/gast.1997.v112.pm9178673]
111. Sadr-Azodi O, Sanders DS, Murray JA, Ludvigsson JF. Patients with celiac disease have an increased risk for pancreatitis. Clin Gastroenterol Hepatol 2012; 10: 1136-1142 [PMID: 22801059 DOI: 10.1016/j.cgh.2012.06.023]
112. Angelini G, Cavallini G, Bovo P, Brocco G, Castagnini A, Lavarini E, Merigo F, Tallon N, Scuro LA. Pancreatic function in chronic inflammatory bowel disease. Int J Pancreatol 1988; 3: 185-193 [PMID: 3361159]
113. Hegnhøj J, Hansen CP, Rannem T, Søbirk H, Andersen LB, Andersen JR. Pancreatic function in Crohn's disease. Gut 1990; 31: 1076-1079 [PMID: 1698692 DOI: 10.1136/ gut.31.9.1076]
114. Seibold F, Scheurlen M, Müller A, Jenss H, Weber P. Impaired pancreatic function in patients with Crohn's disease with and without pancreatic autoantibodies. J Clin Gastroenterol 1996; 22: 202-206 [PMID: 8724258 DOI: 10.1097/0000483 6-199604000-00010]
115. Maconi G, Dominici R, Molteni M, Ardizzone S, Bosani M, Ferrara E, Gallus S, Panteghini M, Bianchi Porro G. Prevalence of pancreatic insufficiency in inflammatory bowel diseases. Assessment by fecal elastase-1. Dig Dis Sci 2008; 53: 262-270 [PMID: 17530399 DOI: 10.1007/s10620-007-9852-y]
116. Beharry S, Ellis L, Corey M, Marcon M, Durie P. How useful is fecal pancreatic elastase 1 as a marker of exocrine pancreatic disease? J Pediatr 2002; 141: 84-90 [PMID: 12091856 DOI: 10.1067/mpd.2002.124829]
117. Nakamura H, Murakami Y, Uemura K, Hayashidani Y, Sudo T, Ohge H, Sueda T. Predictive factors for exocrine pancreatic insufficiency after pancreatoduodenectomy with pancreaticogastrostomy. J Gastrointest Surg 2009; 13: 1321-1327 [PMID: 19415402 DOI: 10.1007/s11605-009-0896-5]
118. Ryan AM, Healy LA, Power DG, Rowley SP, Reynolds JV. Short-term nutritional implications of total gastrectomy for malignancy, and the impact of parenteral nutritional support. Clin Nutr 2007; 26: 718-727 [PMID: 17949863 DOI: 10.1016/j.clnu.2007.08.013]
119. Saito A, Noguchi Y, Yoshikawa T, Doi C, Fukuzawa K, Matsumoto A, Ito T, Tsuburaya A, Nagahara N. Gastrectomized patients are in a state of chronic protein malnutrition analyses of 23 amino acids. Hepatogastroenterology 2001; 48: 585-589 [PMID: 11379360]
120. Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut 2005; 54 Suppl 6: vi1-v28 [PMID: 15951527 DOI: 10.1136/gut.2005.065946]
121. Keller J, Aghdassi AA, Lerch MM, Mayerle JV, Layer P. Tests of pancreatic exocrine function-clinical significance in pancreatic and non-pancreatic disorders. Best Pract Res Clin Gastroenterol 2009; 23: 425-439 [PMID: 19505669 DOI: 10.1016/j.bpg.2009.02.013]
122. Domínguez-Muñoz JE. Pancreatic enzyme replacement therapy: exocrine pancreatic insufficiency after gastrointestinal surgery. HPB (Oxford) 2009; 11 Suppl 3: 3-6 [PMID: 20495625 DOI: 10.1111/j.1477-2574.2009.00132.x]
123. Friess H, Böhm J, Müller MW, Glasbrenner B, Riepl RL, Malfertheiner P, Büchler MW. Maldigestion after total gastrectomy is associated with pancreatic insufficiency. Am J Gastroenterol 1996; 91: 341-347 [PMID: 8607504]
124. Heptner G, Domschke S, Domschke W. Exocrine pancreatic function after gastrectomy. Specificity of indirect tests. Gastroenterology 1989; 97: 147-153 [PMID: 2656361]
125. Gullo L, Costa PL, Ventrucci M, Mattioli S, Viti G, Labò G. Exocrine pancreatic function after total gastrectomy. Scand J Gastroenterol 1979; 14: 401-407 [PMID: 482852]
126. Ihse I, Arnesjö B, Kugelberg C, Lilja P. Intestinal activities of trypsin, lipase, and phospholipase after a test meal. An evaluation of 474 examinations. Scand J Gastroenterol 1977; 12: 663-668 [PMID: 929105 DOI: 10.3109/00365527709181700]
127. Büchler M, Malfertheiner P, Glasbrenner B, Beger HG. [Secondary pancreatic insufficiency following distal stomach resection]. Langenbecks Arch Chir 1985; 367: 41-50 [PMID: 4094513 DOI: 10.1007/BF01241944]
128. Kahl S, Malfertheiner P. Exocrine and endocrine pancreatic insufficiency after pancreatic surgery. Best Pract Res Clin Gastroenterol 2004; 18: 947-955 [PMID: 15494288 DOI: 10.1016/ j.bpg.2004.06.028]
129. Domínguez Muñoz JE. [Physiopathology, diagnosis, and treatment of exocrine pancreatic insufficiency in patients following gastrointestinal or pancreatic surgery]. Gastroenterol Hepatol 2005; 28 Suppl 1: 39-42 [PMID: 15899237]
130. Malagelada JR, Go VL, Summerskill WH. Altered pancreatic and biliary function after vagotomy and pyloroplasty. Gastroenterology 1974; 66: 22-27 [PMID: 4809496]
131. Wormsley KG. The effect of vagotomy on the human pancreatic response to direct and indirect stimulation. Scand J Gastroenterol 1972; 7: 85-91 [PMID: 5010511 DOI: 10.3109/003 65527209180742]
132. Armbrecht U, Lundell L, Stockbrügger RW. The benefit of pancreatic enzyme substitution after total gastrectomy. Aliment Pharmacol Ther 1988; 2: 493-500 [PMID: 2979271 DOI: 10.1111/j.1365-2036.1988.tb00722.x]
133. Brägelmann R, Armbrecht U, Rosemeyer D, Schneider B, Zilly W, Stockbrügger RW. The effect of pancreatic enzyme supplementation in patients with steatorrhoea after total gastrectomy. Eur J Gastroenterol Hepatol 1999; 11: 231-237 [PMID: 10333193 DOI: 10.1097/00042737-199903000-00004]
134. Huddy JR, Macharg FM, Lawn AM, Preston SR. Exocrine pancreatic insufficiency following esophagectomy. Dis Esophagus 2013; 26: 594-597 [PMID: 23199208 DOI: 10.1111/ dote.12004]
135. Stallings VA, Stark LJ, Robinson KA, Feranchak AP, Quinton H. Evidence-based practice recommendations for nutrition-related management of children and adults with cystic fibrosis and pancreatic insufficiency: results of a systematic review. J Am Diet Assoc 2008; 108: 832-839 [PMID: 18442507 DOI: 10.1016/j.jada.2008.02.020]
136. Ockenga J. Importance of nutritional management in diseases with exocrine pancreatic insufficiency. HPB (Oxford) 2009; 11 Suppl 3: 11-15 [PMID: 20495627 DOI: 10.1111/ j.1477-2574.2009.00134.x]
137. Ghaneh P, Neoptolemos JP. Pancreatic exocrine insufficiency following pancreatic resection. Digestion 1999; 60 Suppl 1: 104-110 [PMID: 10026442 DOI: 10.1159/000051464]
138. Matsumoto J, Traverso LW. Exocrine function following the whipple operation as assessed by stool elastase. J Gastrointest Surg 2006; 10: 1225-1229 [PMID: 17114009 DOI: 10.1016/ j.gassur.2006.08.001]
139. Falconi M, Mantovani W, Crippa S, Mascetta G, Salvia R, Pederzoli P. Pancreatic insufficiency after different resections for benign tumours. Br J Surg 2008; 95: 85-91 [PMID: 18041022 DOI: 10.1002/bjs.5652]
140. Lemaire E, O'Toole D, Sauvanet A, Hammel P, Belghiti J, Ruszniewski P. Functional and morphological changes in the pancreatic remnant following pancreaticoduodenectomy with pancreaticogastric anastomosis. Br J Surg 2000; 87: 434-438 [PMID: 10759738 DOI: 10.1046/ j.1365-2168.2000.01388.x]
141. Jang JY, Kim SW, Park SJ, Park YH. Comparison of the functional outcome after pylorus-preserving pancreatoduodenectomy: pancreatogastrostomy and pancreatojejunostomy. World J Surg 2002; 26: 366-371 [PMID: 11865376 DOI: 10.1007/s00268-001-0234-x]
142. Morrow CE, Cohen JI, Sutherland DE, Najarian JS. Chronic pancreatitis: long-term surgical results of pancreatic duct drainage, pancreatic resection, and near-total pancreatectomy and islet autotransplantation. Surgery 1984; 96: 608-616 [PMID: 6435270]
143. Speicher JE, Traverso LW. Pancreatic exocrine function is preserved after distal pancreatectomy. J Gastrointest Surg 2010; 14: 1006-1011 [PMID: 20387129 DOI: 10.1007/ s11605-010-1184-0]
144. Balzano G, Zerbi A, Veronesi P, Cristallo M, Di Carlo V. Surgical treatment of benign and borderline neoplasms of the pancreatic body. Dig Surg 2003; 20: 506-510 [PMID: 14506331 DOI: 10.1159/000073646]
145. Iacono C, Bortolasi L, Serio G. Is there a place for central pancreatectomy in pancreatic surgery? J Gastrointest Surg 1998; 2: 509-516; discussion 516-517 [PMID: 10457309 DOI: 10.1016/S1091-255X(98)80050-4]
146. Warshaw AL, Rattner DW, Fernández-del Castillo C, Z'Graggen K. Middle segment pancreatectomy: a novel technique for conserving pancreatic tissue. Arch Surg 1998; 133: 327-331 [PMID: 9517749 DOI: 10.1001/archsurg.133.3.327]
147. Sudo T, Murakami Y, Uemura K, Hayashidani Y, Hashimoto Y, Ohge H, Sueda T. Middle pancreatectomy with pancreaticogastrostomy: a technique, operative outcomes, and longterm pancreatic function. J Surg Oncol 2010; 101: 61-65 [PMID: 19894223 DOI: 10.1002/jso.21430]
148. Crippa S, Bassi C, Warshaw AL, Falconi M, Partelli S, Thayer SP, Pederzoli P, Fernández-del Castillo C. Middle pancreatectomy: indications, shortand long-term operative outcomes. Ann Surg 2007; 246: 69-76 [PMID: 17592293 DOI: 10.1097/01.sla.0000262790.51512.57]
149. Roggin KK, Rudloff U, Blumgart LH, Brennan MF. Central pancreatectomy revisited. J Gastrointest Surg 2006; 10: 804-812 [PMID: 16769536 DOI: 10.1016/j.gassur.2005.11.012]
150. Falconi M, Zerbi A, Crippa S, Balzano G, Boninsegna L, Capitanio V, Bassi C, Di Carlo V, Pederzoli P. Parenchymapreserving resections for small nonfunctioning pancreatic endocrine tumors. Ann Surg Oncol 2010; 17: 1621-1627 [PMID: 20162460 DOI: 10.1245/s10434-010-0949-8]
151. Bruno MJ, Borm JJ, Hoek FJ, Delzenne B, Hofmann AF, de Goeij JJ, van Royen EA, van Gulik TM, de Wit LT, Gouma DJ, van Leeuwen DJ, Tytgat GN. Comparative effects of enteric-coated pancreatin microsphere therapy after conventional and pylorus-preserving pancreatoduodenectomy. Br J Surg 1997; 84: 952-956 [PMID: 9240133 DOI: 10.1002/ bjs.1800840712]
152. Van Hoozen CM, Peeke PG, Taubeneck M, Frey CF, Halsted CH. Efficacy of enzyme supplementation after surgery for chronic pancreatitis. Pancreas 1997; 14: 174-180 [PMID: 9057190 DOI: 10.1097/00006676-199703000-00010]
153. Neoptolemos JP, Ghaneh P, Andrén-Sandberg A, Bramhall S, Patankar R, Kleibeuker JH, Johnson CD. Treatment of pancreatic exocrine insufficiency after pancreatic resection. Results of a randomized, double-blind, placebo-controlled, crossover study of high vs standard dose pancreatin. Int J Pancreatol 1999; 25: 171-180 [PMID: 10453419]
154. Morawski JH, Prüfert A, van Engen A, Foerster D, Sander-Struckmeier S, Małecka-Panas E, Pezzilli R. Costeffectiveness analysis of pancreatin minimicrospheres in patients with pancreatic exocrine insufficiency due to chronic pancreatitis. J Med Econ 2012; 15 Suppl 1: 15-25 [PMID: 23043594 DOI: 10.3111/13696998.2012.737882]
155. Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 2001; 120: 682-707 [PMID: 11179244 DOI: 10.1053/ gast.2001.22586]