We studied the occurrence and extent of
malnutrition and maldigestion in 13 patients who underwent
pancreatoduodenectomy (PD) and injection of
Neoprene (
polychloroprene) (NI) into the duct of Wirsung, which results in
sclerosis of hte acinar pancreatic tissue, but spares the endocrine function. At discharge, patients under took an
enzyme supplementation regimen with
pancreatin (18, 00 United States Pharmacopoeia units of
lipase per meal). Patients were rehospitalized 24.9 months after PD plus NI to undergo nutritional and metabolic evaluation (hospital control). Nutritional status was evaluated by measuring the
serum albumin level, total
iron binding capacity and total lymphocyte count. Digestive function was assessed by the
D-xylose tolerance test and determination of fecal fat excretion. Patients were then discharged with
pancrelipase, enteric-coated
microspheres (ECM) supplementation (16,050 United States Pharmacopoeia units of
lipase per meal).
Malnutrition, defined as the occurrence of at least two abnormal nutritional parameters, was observed in six patients at hospital control. After six months on
pancrelipase ECM, the nutritional status was re-evaluated in nine patients (three previously malnourished) who were all well nourished. The mean
body weight was 84.7 per cent of usual
body weight at discharge after PD plus NI and raised to 88.0 per cent at the hospital control (p less than 0.01) and to 93.7 per cent )p less than 0.05) after six months on
pancrelipase ECM. At hospital control, results from the
D-xylose test were normal in all patients, and
steatorrhea dropped from 33.6 grams per day without
enzyme supplementation to 15.3 grams per day with
pancrelipase ECM (16,050 United States Pharmacopoeia units of
lipase per meal).
Steatorrhea was incompletely but satisfactorily corrected by
pancrelipase ECM. On supplementation
therapy with
pancrelipase ECM, patients recover a good deal of the
body weight and normalize the biochemical indices of
malnutrition.