Advertisement

Obesity Surgery

, Volume 24, Issue 12, pp 2025–2030 | Cite as

Acute Pancreatitis in Patients After Bariatric Surgery: Incidence, Outcomes, and Risk Factors

  • Arthi Kumaravel
  • Andrea Zelisko
  • Philip Schauer
  • Rocio Lopez
  • Matthew KrohEmail author
  • Tyler Stevens
Original Contributions

Abstract

Background

The incidence of acute pancreatitis (AP) in bariatric surgery patients is not known. Ouraim was to determine the incidence, outcomes, and risk factors of AP in post-bariatric surgery patients.

Methods

An historical cohort study was conducted of all patients who underwent Roux-en-Y gastric bypass, sleeve gastrectomy, adjustable gastric banding, and revisional procedures at our institution from January 2004 to September 2011. Patients who developed AP were identified by review of the electronic medical record. A nested case-control study using Cox regression analysis was done to identify risk factors.

Results

A total of 2695 patients underwent bariatric surgery. Twenty-eight patients (1.04 %) developed AP during a median follow-up of 3.5 years (interquartile range [IQR] 1.9–5.8). One patient had severe AP, and there was one AP-related death. In the case-control study, the only baseline variable that predicted post-operative AP was a prior history of AP. Three other variables identified after surgery were associated with AP: (1) rapid weight loss as measured by percent of excess weight loss (EWL) at the first post-operative visit, (2) abnormal findings on post-operative ultrasound (stones, sludge or ductal dilation), and (3) post-operative complications of bowel leak or anastomotic stricture.

Conclusions

The incidence of AP in this cohort is 1.04 %, which is higher than that reported for the general population (~17/100,000, 0.017 %). Most cases were clinically mild and managed conservatively with good outcomes. Rapid post-operative weight loss and the presence of gallstones or sludge on post-operative ultrasound were significant risk factors for AP.

Keywords

Acute pancreatitis Bariatric surgery Incidence Outcomes Risk factors 

Abbreviations

AP

Acute pancreatitis

BISAP

Bedside index of severity of AP

BMI

Body mass index

CBD

Common bile duct

CT

Computed tomography

ERCP

Endoscopic retrograde cholangiopancreatography

EWL

Excess weight loss

LFT

Liver function test

NHANES

National Health and Nutrition Examination Survey

SOD

Sphincter of Oddi dysfunction

US

Ultrasound

Notes

Conflict of Interest

Arthi Kumaravel — no conflict of interest. Andrea Zelisko — no conflict of interest. Philip Schauer — personal fees from Ethicon, personal fees from Lilly, personal fees from Nestle, other from Stryker, other from Surgiquest, other from Barosense, other from RemedyMD, personal fees and other from Physicians Review of Surgery, LLC, personal fees and other from Quadrant Healthcare, LLC, other from SE healthcare quality Consulting, other from Springer Publishing Company, grants from Ethicon, grants from National Institues of Health, outside the submitted work; In addition, Dr. Schauer has a patent Medical devices for weight loss pending. Rocio Lopez — no conflict of interest. Matthew Kroh — mo conflict of interest. Tyler Stevens — personal fees from Abbvie and Boston Scientific outside the submitted work.

Author Contributions

Arthi Kumaravel — study concept and design; data acquisition; interpretation of data; drafting of manuscript.

Andrea Zelisko — study concept and design; data acquisition; interpretation of data.

Philip Schauer — interpretation of data; critical revision of manuscript for intellectual content.

Rocio Lopez — study concept and design; analysis; drafting of manuscript.

Matthew Kroh — study concept and design; interpretation of data; critical revision of manuscript for intellectual content.

Tyler Stevens — study concept and design; interpretation of data; critical revision of manuscript for intellectual content.

References

  1. 1.
    Flegal KM, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among US adults,–2010. JAMA. 2012;307(5):491–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Nguyen NT, Masoomi H, Magno CP, et al. Trends in use of bariatric surgery, 2003–2008. J Am Coll Surg. 2011;213(2):261–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Bertin PM, Singh K, Arregui ME. Laparoscopic transgastric endoscopic retrograde cholangiopancreatography (ERCP) after gastric bypass: case series and a description of technique. Surg Endosc. 2011;25(8):2592–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Emmett DS, Mallat DB. Double-balloon ERCP in patients who have undergone roux-en-Y surgery: a case series. Gastrointest Endosc. 2007;66(5):1038–41.PubMedCrossRefGoogle Scholar
  5. 5.
    Falcao M, Campos JM, Neto MG, et al. Transgastric endoscopic retrograde cholangiopancreatography for the management of biliary tract disease after roux-en-Y gastric bypass treatment for obesity. Obes Surg. 2012;22(6):872–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Lopes TL, Clements RH, Wilcox CM. Laparoscopy-assisted ERCP: experience of a high-volume bariatric surgery center (with video). Gastrointest Endosc. 2009;70(6):1254–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Patel JA, Patel NA, Shinde T, et al. Endoscopic retrograde cholangiopancreatography after laparoscopic roux-en-Y gastric bypass: a case series and review of the literature. Am Surg. 2008;74(8):689,93. discussion 693–4.Google Scholar
  8. 8.
    Schreiner MA, Chang L, Gluck M, et al. Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP in bariatric post-roux-en-Y gastric bypass patients. Gastrointest Endosc. 2012;75(4):748–56.PubMedCrossRefGoogle Scholar
  9. 9.
    Tekola B, Wang AY, Ramanath M, et al. Percutaneous gastrostomy tube placement to perform transgastrostomy endoscopic retrograde cholangiopancreaticography in patients with roux-en-Y anatomy. Dig Dis Sci. 2011;56(11):3364–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Wright BE, Cass OW, Freeman ML. ERCP in patients with long-limb roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc. 2002;56(2):225–32.PubMedCrossRefGoogle Scholar
  11. 11.
    Banks PA, Freeman ML. Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101(10):2379–400.PubMedCrossRefGoogle Scholar
  12. 12.
    Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–11.PubMedCrossRefGoogle Scholar
  13. 13.
    Badalov N, Baradarian R, Iswara K, et al. Drug-induced acute pancreatitis: an evidence-based review. Clin Gastroenterol Hepatol. 2007;5(6):648–61. quiz–644.PubMedCrossRefGoogle Scholar
  14. 14.
    Brown A, Young B, Morton J, et al. Are health related outcomes in acute pancreatitis improving? An analysis of national trends in the U.S. from 1997 to 2003. JOP. 2008;9(4):408–14.PubMedGoogle Scholar
  15. 15.
    Martinez J, Johnson CD, Sanchez-Paya J, et al. Obesity is a definitive risk factor of severity and mortality in acute pancreatitis: an updated meta-analysis. Pancreatology. 2006;6(3):206–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Hong S, Qiwen B, Ying J, et al. Body mass index and the risk and prognosis of acute pancreatitis: a meta-analysis. Eur J Gastroenterol Hepatol. 2011;23(12):1136–43.PubMedCrossRefGoogle Scholar
  17. 17.
    Lee YH, Pratley RE. The evolving role of inflammation in obesity and the metabolic syndrome. Curr Diabetes Rep. 2005;5(1):70–5.CrossRefGoogle Scholar
  18. 18.
    Evans AC, Papachristou GI, Whitcomb DC. Obesity and the risk of severe acute pancreatitis. Minerva Gastroenterol Dietol. 2010;56(2):169–79.PubMedGoogle Scholar
  19. 19.
    van Dielen FM, Buurman WA, Hadfoune M, et al. Macrophage inhibitory factor, plasminogen activator inhibitor-1, other acute phase proteins, and inflammatory mediators normalize as a result of weight loss in morbidly obese subjects treated with gastric restrictive surgery. J Clin Endocrinol Metab. 2004;89(8):4062–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Uzun H, Zengin K, Taskin M, et al. Changes in leptin, plasminogen activator factor and oxidative stress in morbidly obese patients following open and laparoscopic Swedish adjustable gastric banding. Obes Surg. 2004;14(5):659–65.PubMedCrossRefGoogle Scholar
  21. 21.
    Miller GD, Nicklas BJ, Fernandez A. Serial changes in inflammatory biomarkers after roux-en-Y gastric bypass surgery. Surg Obes Relat Dis. 2011;7(5):618–24.PubMedCrossRefGoogle Scholar
  22. 22.
    Morgan KA, Glenn JB, Byrne TK, et al. Sphincter of oddi dysfunction after roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5(5):571–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Woods CM, Mawe GM, Toouli J, et al. The sphincter of Oddi: understanding its control and function. Neurogastroenterol Motil. 2005;17 Suppl 1:31–40.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Arthi Kumaravel
    • 1
  • Andrea Zelisko
    • 2
  • Philip Schauer
    • 3
  • Rocio Lopez
    • 4
  • Matthew Kroh
    • 5
    Email author
  • Tyler Stevens
    • 6
  1. 1.Department of Gastroenterology and Hepatology, A31Cleveland Clinic FoundationClevelandUSA
  2. 2.Bariatric and Metabolic InstituteCleveland Clinic FoundationClevelandUSA
  3. 3.Bariatric and Metabolic Institute, M61Cleveland Clinic FoundationClevelandUSA
  4. 4.Quantitative Health SciencesCleveland Clinic FoundationClevelandUSA
  5. 5.Bariatric and Metabolic Institute, A100Cleveland Clinic FoundationClevelandUSA
  6. 6.Department of Gastroenterology and Hepatology, Q3Cleveland Clinic FoundationClevelandUSA

Personalised recommendations