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

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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.

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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

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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.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, A31, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Arthi Kumaravel

  2. Bariatric and Metabolic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Andrea Zelisko

  3. Bariatric and Metabolic Institute, M61, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Philip Schauer

  4. Quantitative Health Sciences, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Rocio Lopez

  5. Bariatric and Metabolic Institute, A100, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Matthew Kroh

  6. Department of Gastroenterology and Hepatology, Q3, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Tyler Stevens

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  1. Arthi Kumaravel
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  2. Andrea Zelisko
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Corresponding author

Correspondence to Matthew Kroh.

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Kumaravel, A., Zelisko, A., Schauer, P. et al. Acute Pancreatitis in Patients After Bariatric Surgery: Incidence, Outcomes, and Risk Factors. OBES SURG 24, 2025–2030 (2014). https://doi.org/10.1007/s11695-014-1337-4

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  • DOI: https://doi.org/10.1007/s11695-014-1337-4

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