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Background and Aim <p>Acute necrotizing pancreatitis (ANP) is associated with pancreatic parenchymal necrosis and may lead to exocrine and endocrine dysfunction. However, the natural course and determinants of pancreatic functional impairment remain incompletely defined. We prospectively evaluated the pancreatic exocrine and endocrine function in patients with ANP and attempted to identify associated risk factors.</p> Methods <p>Patients aged 18–80&#xa0;years with ANP defined by the&#xa0;Revised Atlanta Classification&#xa0;were enrolled and prospectively followed for 6&#xa0;months. Exocrine function was assessed using fecal elastase-1 (FE-1), and endocrine function was evaluated using fasting glucose, postprandial glucose, HbA1c, and homeostatic model assessment of insulin resistance (HOMA-IR). Clinical severity, etiology, anatomic distribution of necrosis, infected necrosis, and interventions were analyzed as predictors of dysfunction.</p> Results <p>Thirty patients completed 6-month follow-up. At 6&#xa0;months, exocrine insufficiency occurred in 40% of patients (mild 16.7%, severe 23.3%). Endocrine dysfunction was observed in 30% of patients, including diabetes mellitus (6.7%) and prediabetes (23.3%). Necrosis involving the pancreatic head was significantly associated with exocrine insufficiency (<i>p</i> = 0.003). Moderately severe acute pancreatitis independently predicted exocrine dysfunction (<i>p</i> = 0.01). No clinical or radiologic factor predicted endocrine insufficiency.</p> Conclusion <p>Exocrine insufficiency appears to be relatively common following ANP, with a possible association observed in patients with moderately severe disease and head-dominant necrosis; however, these findings require further validation. Endocrine dysfunction was observed in approximately one-third of patients, but no consistent predictors were identified in this cohort.</p>

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Incidence and Determinants of Pancreatic Insufficiency After Acute Necrotizing Pancreatitis: A Prospective Study

  • 期刊论文

  • 发表日期：

    2026年5月19日

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  • Vandit Desai,
  • Sanish Ancil,
  • Rajesh Gupta,
  • Mandeep Kang,
  • Sanjay Kumar Bhadada,
  • Arun Kumar Sharma,
  • Vaneet Jearth,
  • Surinder Singh Rana

摘要

Background and Aim

Acute necrotizing pancreatitis (ANP) is associated with pancreatic parenchymal necrosis and may lead to exocrine and endocrine dysfunction. However, the natural course and determinants of pancreatic functional impairment remain incompletely defined. We prospectively evaluated the pancreatic exocrine and endocrine function in patients with ANP and attempted to identify associated risk factors.

Methods

Patients aged 18–80 years with ANP defined by the Revised Atlanta Classification were enrolled and prospectively followed for 6 months. Exocrine function was assessed using fecal elastase-1 (FE-1), and endocrine function was evaluated using fasting glucose, postprandial glucose, HbA1c, and homeostatic model assessment of insulin resistance (HOMA-IR). Clinical severity, etiology, anatomic distribution of necrosis, infected necrosis, and interventions were analyzed as predictors of dysfunction.

Results

Thirty patients completed 6-month follow-up. At 6 months, exocrine insufficiency occurred in 40% of patients (mild 16.7%, severe 23.3%). Endocrine dysfunction was observed in 30% of patients, including diabetes mellitus (6.7%) and prediabetes (23.3%). Necrosis involving the pancreatic head was significantly associated with exocrine insufficiency (p = 0.003). Moderately severe acute pancreatitis independently predicted exocrine dysfunction (p = 0.01). No clinical or radiologic factor predicted endocrine insufficiency.

Conclusion

Exocrine insufficiency appears to be relatively common following ANP, with a possible association observed in patients with moderately severe disease and head-dominant necrosis; however, these findings require further validation. Endocrine dysfunction was observed in approximately one-third of patients, but no consistent predictors were identified in this cohort.