P2172 - Evaluation of Exocrine Pancreatic Insufficiency Testing and Pancreatic Enzyme Replacement Therapy Utilization in Patients With Pancreatic Ductal Adenocarcinoma

Brendan McQuillen, MD, MS, Agnieszka Maniak, MD, Kanika Garg, MD, Thomas J. Wang, MD, Neal A. Mehta, MD, Ajaypal Singh, MD, Irving Waxman, MD, FACG
Rush University Medical Center, Chicago, IL

Introduction: Pancreatic ductal adenocarcinoma (PDAC) continues to have a dismal prognosis. Exocrine pancreatic insufficiency (EPI) is a common yet often underrecognized complication in PDAC, affecting up to 90% of patients with unresectable cancer and 40-50% of patients with resectable cancer. Further, the clinical manifestations of EPI can severely impact patients' quality of life, potentially influence treatment tolerance, and overall survival outcomes. Pancreatic Enzyme Replacement Therapy (PERT) is the standard treatment for EPI and has been shown to improve nutritional status, reduce gastrointestinal symptoms, and enhance quality of life in patients with EPI. In this study, we aim to assess the frequency of EPI testing and the rate of PERT prescription in a cohort of patients with PDAC.

Methods: This is a single center retrospective study at a tertiary care center. All patients diagnosed with pancreatic adenocarcinoma and discussed at a multidisciplinary tumor board between October 2021 – September 2024 were included.

Results: 78 patients with PDAC were included (average age 68.9 +/- 11.6, 25% were female). 34 patients (43.5%) were prescribed PERT (Figure 1), but only 19/34 (55.9%) were prescribed the correct dosing on initial prescription. A total of 7/78 patients (9.0%) were tested for EPI (all by assessing fecal elastase). Among these, one patient had normal fecal elastase, and one patient failed to be prescribed PERT despite confirmed EPI. Only 6 patients (18.2%) had confirmed EPI prior to initiating therapy. Notably, 5 patients (15.2%) were initially prescribed loperamide for symptomatic EPI, delaying the initiation of PERT. Most patients who were prescribed PERT were not tested for EPI beforehand. None of the patients were assessed for fat soluble vitamin deficiency. Diarrhea was reported in 47 patients (60.3%), though this may have been confounded by concurrent chemotherapy treatment for many patients.

Discussion: This study provides insights into the current practices of EPI management in PDAC patients. It highlights a significant gap in both prescribing and correctly dosing PERT. By increasing the awareness of EPI in this patient population and its positive implications on survival and quality of life, there is an opportunity to improve comprehensive care and hopefully, outcomes.

Disclosures:
Brendan McQuillen indicated no relevant financial relationships.
Agnieszka Maniak indicated no relevant financial relationships.
Kanika Garg indicated no relevant financial relationships.
Thomas Wang indicated no relevant financial relationships.
Neal Mehta: Boston Scientific – Consultant. Castle Biosciences – Consultant. ConMed – Consultant. Medtronic – Consultant. Olympus – Consultant.
Ajaypal Singh: Boston Scientific – Consultant. Creo – Consultant. Olympus – Consultant.
Irving Waxman: Boston Scientific – Consultant. Cook Medical – Consultant. Medtronic – Consultant.

Brendan McQuillen, MD, MS, Agnieszka Maniak, MD, Kanika Garg, MD, Thomas J. Wang, MD, Neal A. Mehta, MD, Ajaypal Singh, MD, Irving Waxman, MD, FACG. P2172 - Evaluation of Exocrine Pancreatic Insufficiency Testing and Pancreatic Enzyme Replacement Therapy Utilization in Patients With Pancreatic Ductal Adenocarcinoma, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.