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Background <p>Pancreatic exocrine insufficiency (PEI) is an underrecognized complication following metabolic bariatric surgery (MBS). PEI may lead to weight loss, diarrhea, abdominal distension, and fat malabsorption, thereby adversely affecting postoperative nutritional status and quality of life.</p> Objective <p>This systematic review and meta-analysis aimed to estimate the incidence of PEI after MBS and to compare PEI incidence across different bariatric surgical procedures.</p> Methods <p>A systematic literature search was conducted in five major databases including PubMed, Embase, Web of Science, Cochrane Library, and Scopus from inception to 29 December 2025. Studies reporting the incidence of PEI after MBS were included. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Pooled incidence estimates and procedure-specific subgroup analyses were performed using Stata version 17.0.</p> Results <p>Twelve studies involving 1,157 patients were included, and all 12 studies reported postoperative PEI incidence after MBS. The pooled incidence of PEI following MBS was 24% (95% CI: 15% to 32%). Subgroup analyses according to surgical procedure demonstrated that biliopancreatic diversion with duodenal switch (BPD/DS) was associated with a high PEI incidence of 43% (95% CI: 5% to 80%). Other bariatric procedures showed variable PEI incidence, indicating substantial heterogeneity across surgical techniques.</p> Conclusions <p>PEI occurs frequently after MBS, with incidence varying by surgical procedure. Malabsorptive procedures, particularly BPD/DS, appear to confer a higher risk of PEI. Routine postoperative assessment of pancreatic exocrine function may be warranted, especially in patients undergoing high-risk bariatric procedures.</p>

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Incidence of Secondary Pancreatic Exocrine Insufficiency after Metabolic Bariatric Surgery: a Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2026年3月14日

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  • Chenglou Zhu,
  • Wenhan Liu

摘要

Background

Pancreatic exocrine insufficiency (PEI) is an underrecognized complication following metabolic bariatric surgery (MBS). PEI may lead to weight loss, diarrhea, abdominal distension, and fat malabsorption, thereby adversely affecting postoperative nutritional status and quality of life.

Objective

This systematic review and meta-analysis aimed to estimate the incidence of PEI after MBS and to compare PEI incidence across different bariatric surgical procedures.

Methods

A systematic literature search was conducted in five major databases including PubMed, Embase, Web of Science, Cochrane Library, and Scopus from inception to 29 December 2025. Studies reporting the incidence of PEI after MBS were included. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Pooled incidence estimates and procedure-specific subgroup analyses were performed using Stata version 17.0.

Results

Twelve studies involving 1,157 patients were included, and all 12 studies reported postoperative PEI incidence after MBS. The pooled incidence of PEI following MBS was 24% (95% CI: 15% to 32%). Subgroup analyses according to surgical procedure demonstrated that biliopancreatic diversion with duodenal switch (BPD/DS) was associated with a high PEI incidence of 43% (95% CI: 5% to 80%). Other bariatric procedures showed variable PEI incidence, indicating substantial heterogeneity across surgical techniques.

Conclusions

PEI occurs frequently after MBS, with incidence varying by surgical procedure. Malabsorptive procedures, particularly BPD/DS, appear to confer a higher risk of PEI. Routine postoperative assessment of pancreatic exocrine function may be warranted, especially in patients undergoing high-risk bariatric procedures.