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Pancrelipase with branched-chain amino acids for preventing nonalcoholic fatty liver disease after pancreaticoduodenectomy

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

To investigate the efficacy of the early administration of pancreatic enzymes combined with an elemental diet of branched-chain amino acids (BCAA) for nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD).

Methods

Data were obtained for 122 consecutive patients who underwent PD. High-titer pancrelipase and a BCAA-rich solution was administered via a feeding tube beginning on postoperative day (POD) 4 (PB group: n = 31). Ninety-one patients who underwent PD prior to this treatment were included as a control group (n = 91). The radiological changes in the liver and pancreatic parenchyma related to NAFLD before and after PD were assessed on CT, and trends in liver function and nutritional status were evaluated over the 180-day post-PD period.

Results

Patient background factors, histopathology and operation-related variables were not significantly different between the two groups. Liver attenuation [56 HU (−13 to 73) vs. 61 (26 to 69), p = 0.015] and the liver-to-spleen attenuation ratio [1.12 (−0.38 to 1.48) vs. 1.24 (0.89 to 1.49), p = 0.018] were significantly decreased, and the pancreatic parenchyma was significantly thinner [17.9 mm (8.6–25.3) vs. 13.9 mm (2.5–23.2), p = 0.02] in the control group at 3 months after the operation. The alanine aminotransferase levels were also higher in the control group (p < 0.05, at POD 14, 30, 60 and 90), while the serum albumin (p < 0.05, at POD 30, 60 and 180) and total protein (p < 0.05, at POD 30, 60, 90 and 180) levels were significantly better in the PB group.

Conclusions

Early supplementation of high-titer pancrelipase combined with a BCAA-rich elemental diet reduces the risk of NAFLD after PD.

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Authors and Affiliations

  1. Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ohyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan

    Shintaro Yamazaki, Tadatoshi Takayama, Tokio Higaki, Masamichi Moriguchi, Nao Yoshida, Teruyuki Miyazaki & Yoichi Teshima

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  1. Shintaro Yamazaki
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  2. Tadatoshi Takayama
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  3. Tokio Higaki
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  4. Masamichi Moriguchi
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  5. Nao Yoshida
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  6. Teruyuki Miyazaki
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  7. Yoichi Teshima
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Correspondence to Tadatoshi Takayama.

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Yamazaki, S., Takayama, T., Higaki, T. et al. Pancrelipase with branched-chain amino acids for preventing nonalcoholic fatty liver disease after pancreaticoduodenectomy. J Gastroenterol 51, 55–62 (2016). https://doi.org/10.1007/s00535-015-1077-9

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  • DOI: https://doi.org/10.1007/s00535-015-1077-9

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