P4357 - The Incidence of Exocrine Pancreatic Insufficiency Following an Index Episode of Acute Necrotizing Pancreatitis: A Comprehensive Systematic Review and Meta-Analysis

Ujwala Pamidimukkala, MD¹, Vikram Ram. Rajagopalan, MBBS¹, Azizullah Beran, MD¹, Awais Ahmed, MD¹, Mina Batarseh, MD¹, Hussein Baydoun, MD¹, Aladdin Dahbour, MD¹, Nasir Saleem, MD¹, Daryl Ramai, MD, MPH, MSc², Mohannad Yousef, MD³, Mohammad Al-Haddad, MD¹, Itegbemie Obaitan, MD, MPH¹
1Indiana University School of Medicine, Indianapolis, IN; 2Brigham and Women’s Hospital, Harvard Medical School, Salt Lake City, UT; 3Michigan State University/Hurley Medical Center, Flint, MI

Introduction: Acute necrotizing pancreatitis (ANP) is a severe form of pancreatitis that can lead to long-term complications even after recovery, including exocrine pancreatic insufficiency (EPI). EPI can precipitate numerous systemic downstream effects, such as coagulopathies and osteomalacia, due to malabsorption. The incidence of EPI following an initial episode of acute ANP varies in existing literature. To address this, we performed a systematic review and meta-analysis to quantitatively evaluate the incidence of EPI after ANP.

Methods: We performed a comprehensive literature search of PubMed from inception to May 23, 2025 to include all studies reporting the incidence of EPI after an index episode of ANP. Studies including children and conference abstracts were excluded. Two independent reviewers (UP and AB) screened articles and extracted relevant data from each study, which included the number of patients with ANP and the number of these patients who later developed EPI. Statistical analysis was performed using Comprehensive Meta-Analysis (Biostat, CO, USA). The random-effects model and DerSimonian Laird method were used to calculate the pooled event rates and 95% confidence intervals (CI). The Higgins I² index was used to assess heterogeneity, with I²>50% indicating significant heterogeneity.

Results: A total of 20 studies with 1,645 patients with ANP were included in the final analysis. The pooled incidence of EPI was 43.5% (95% CI 0.331-0.544, I²=90.462, Figure 1). A leave-one-out sensitivity analysis yielded similar results. Subgroup analyses for patients who underwent objective EPI testing showed a pooled EPI incidence of 42.3% (95% CI 0.286-0.574, I²=90.367, Figure 2) in patients who underwent fecal elastase testing and 35.7% (95% CI 0.203-0.548, I²=62.024, Figure 2) in patients who had fecal fat testing done.

Discussion: The demonstrated high EPI incidence following an index episode of ANP provides more evidence that routine monitoring for EPI and prompt initiation of treatment in this patient population are important to prevent malabsorption-related complications. Prospective multi-center studies are needed to substantiate our findings.


Figure: Figure 1: Forest plot showing the pooled incidence of exocrine pancreatic insufficiency (EPI) in acute necrotizing pancreatitis. Abbreviation: CI: confidence interval.


Figure: Figure 2: Forest plot showing pooled incidence of exocrine pancreatic insufficiency (EPI) in acute necrotizing pancreatitis based on type of testing for EPI. Abbreviations: CI: confidence interval, PERT: pancreatic enzyme replacement therapy.

Disclosures:
Ujwala Pamidimukkala indicated no relevant financial relationships.
Vikram Rajagopalan indicated no relevant financial relationships.
Azizullah Beran indicated no relevant financial relationships.
Awais Ahmed indicated no relevant financial relationships.
Mina Batarseh indicated no relevant financial relationships.
Hussein Baydoun indicated no relevant financial relationships.
Aladdin Dahbour indicated no relevant financial relationships.
Nasir Saleem indicated no relevant financial relationships.
Daryl Ramai indicated no relevant financial relationships.
Mohannad Yousef indicated no relevant financial relationships.
Mohammad Al-Haddad: Amplified Sciences – Grant/Research Support. Boston Scientific – Consultant. Interpace diagnostics – Consultant.
Itegbemie Obaitan indicated no relevant financial relationships.

Ujwala Pamidimukkala, MD¹, Vikram Ram. Rajagopalan, MBBS¹, Azizullah Beran, MD¹, Awais Ahmed, MD¹, Mina Batarseh, MD¹, Hussein Baydoun, MD¹, Aladdin Dahbour, MD¹, Nasir Saleem, MD¹, Daryl Ramai, MD, MPH, MSc², Mohannad Yousef, MD³, Mohammad Al-Haddad, MD¹, Itegbemie Obaitan, MD, MPH¹. P4357 - The Incidence of Exocrine Pancreatic Insufficiency Following an Index Episode of Acute Necrotizing Pancreatitis: A Comprehensive Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.