P4345 - The Impact of Bariatric Surgery on Pancreatic Adenocarcinoma and Exocrine Pancreatic Insufficiency Risk in Patients With Chronic Pancreatitis and Morbid Obesity: A National Readmission Database Analysis

Khalid Ahmed, MD¹, Zachary Leslie, ², Yasmin O. Ali, MBBS³, Eric Wise, MD, MA⁴, Martin Freeman, MD¹, Stuart K. Amateau, MD, PhD⁵, Ahmed Dirweesh, MD⁵
1University of Minnesota, Minneapolis, MN; 2UMN, Minneapolis, MN; 3Hennepin Healthcare, Minneapolis, MN; 4University of Minnesota Medical School, Minneapolis, MN; 5University of Minnesota Medical Center, Minneapolis, MN

Introduction: Morbid obesity is associated with a higher incidence of chronic pancreatitis (CP). While bariatric surgery is known to reduce the risk of pancreatic adenocarcinoma (PAC) and exocrine pancreatic insufficiency (EPI) in patients with a healthy pancreas, its impact on those with preexisting CP is unclear. We aimed to evaluate whether prior bariatric surgery affects the risk of PAC and EPI in patients with CP and morbid obesity.

Methods: Using the Nationwide Readmissions Database (2016–2022), adults with a diagnosis of CP and either morbid obesity or a history of bariatric surgery were identified. Demographics, comorbidities, and hospital factors were assessed. Univariate and multivariable logistic regressions were used to evaluate the association between prior bariatric surgery and 180-day outcomes of PAC and EPI.

Results: A total of 28,026 patients with 31.5% having bariatric surgery. These patients were younger, more females, and had lower Charlson comorbidity scores (Table 1.). EPI occurred in 4.6% of the total cohort and PAC in 1.3%. EPI was more common in the bariatric surgery group (4.9% vs. 4.4%, p< 0.001), while PAC rates were similar (1.2% vs. 1.3%, p=0.88) (Figure 1). Multivariable analysis showed bariatric surgery was significantly associated with increased EPI risk (OR: 1.64; 95% CI: 1.18–2.27; p< 0.05), but not with PAC (OR: 1.03; p=0.73). No variables were associated with both increased risk of EPI and pancreatic cancer or decreased risk of each condition. Higher BMI was associated with reduced EPI risk (OR: 0.77 [0.66,0.90], p< 0.05) as well as a nearly significant associated risk for patients with pancreatic cancer (OR: 0.95 [0.89,1.01], p = 0.11).

Discussion: Contrary to its proven effectiveness in reducing pancreatic cancer risk in the general obese population; bariatric surgery's protective effect does not appear to extend to patients with chronic pancreatitis, and it should not be relied upon as a strategy for reducing PAC risk in CP. This highlights the need for alternative strategies and vigilant surveillance to manage cancer risk in this high-risk group. Similarly, these interventions should not be routinely recommended for patients with CP, particularly those exhibiting significant pancreatic dysfunction, as it may accelerate the progression to insufficiency and long-term complications.


Figure: Figure 1: Rates of exocrine pancreatic insufficiency and pancreatic adenocarcinoma in the Nationwide Readmissions Database from 2016 to 2022. Correlation adjusted errors bars used to denote uncertainty in sample design.


Figure: Table 1: Characteristics and outcomes for patients in the Nationwide Readmissions Database from the first 6 months for each of 2016 to 2022 with diagnosis of chronic pancreatitis and either a history of bariatric surgery or morbid obesity or both stratified by prior history of bariatric surgery.

Disclosures:
Khalid Ahmed indicated no relevant financial relationships.
Zachary Leslie indicated no relevant financial relationships.
Yasmin Ali indicated no relevant financial relationships.
Eric Wise indicated no relevant financial relationships.
Martin Freeman indicated no relevant financial relationships.
Stuart Amateau: BSC – Consultant. Cook – Consultant. Endo-Therapeutics – Consultant. Merit – Consultant. Olympus – Advisor or Review Panel Member, Consultant. Provation – Advisory Committee/Board Member. Steris – Consultant.
Ahmed Dirweesh indicated no relevant financial relationships.

Khalid Ahmed, MD¹, Zachary Leslie, ², Yasmin O. Ali, MBBS³, Eric Wise, MD, MA⁴, Martin Freeman, MD¹, Stuart K. Amateau, MD, PhD⁵, Ahmed Dirweesh, MD⁵. P4345 - The Impact of Bariatric Surgery on Pancreatic Adenocarcinoma and Exocrine Pancreatic Insufficiency Risk in Patients With Chronic Pancreatitis and Morbid Obesity: A National Readmission Database Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.