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Ausania, FAuthorFernandez-Cruz, LAuthorVaquero, EcAuthor

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Review

Evidence-based Guidelines for the Management of Exocrine Pancreatic Insufficiency After Pancreatic Surgery

Publicated to:Annals Of Surgery. 264 (6): 949-958 - 2016-01-01 264(6), DOI: 10.1097/SLA.0000000000001732

Authors: Sabater, Luis; Ausania, Fabio; Bakker, Olaf J.; Boadas, Jaume; Enrique Dominguez-Munoz, J.; Falconi, Massimo; Fernandez-Cruz, Laureano; Frulloni, Luca; Gonzalez-Sanchez, Victor; Larino-Noia, Jose; Lindkvist, Bjorn; Lluis, Felix; Morera-Ocon, Francisco; Martin-Perez, Elena; Marra-Lopez, Carlos; Moya-Herraiz, Angel; Neoptolemos, John P.; Pascual, Isabel; Perez-Aisa, Angeles; Pezzilli, Raffaele; Ramia, Jose M.; Sanchez, Belinda; Molero, Xavier; Ruiz-Montesinos, Inmaculada; Vaquero, Eva C.; de-Madaria, Enrique;

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Abstract

To provide evidence-based recommendations for the management of exocrine pancreatic insufficiency (EPI) after pancreatic surgery.EPI is a common complication after pancreatic surgery but there is certain confusion about its frequency, optimal methods of diagnosis, and when and how to treat these patients.Eighteen multidisciplinary reviewers performed a systematic review on 10 predefined questions following the GRADE methodology. Six external expert referees reviewed the retrieved information. Members from Spanish Association of Pancreatology were invited to suggest modifications and voted for the quantification of agreement.These guidelines analyze the definition of EPI after pancreatic surgery, (one question), its frequency after specific techniques and underlying disease (four questions), its clinical consequences (one question), diagnosis (one question), when and how to treat postsurgical EPI (two questions) and its impact on the quality of life (one question). Eleven statements answering those 10 questions were provided: one (9.1%) was rated as a strong recommendation according to GRADE, three (27.3%) as moderate and seven (63.6%) as weak. All statements had strong agreement.EPI is a frequent but under-recognized complication of pancreatic surgery. These guidelines provide evidence-based recommendations for the definition, diagnosis, and management of EPI after pancreatic surgery.

Keywords

DiagnosisDistal pancreatectomyEvidence-based medicineExocrine pancreatic insufficiencyGuidelinesHead resectionHumansNecrotizing pancreatitisPancreasPancreaticPancreatic diseasesPancreatic exocrine insufficiencyPatient-reported outcomesPostoperative complicationsPractice guidelines as topicPylorus-preserving-pancreaticoduodenectomyQuality-of-lifeRandomized clinical-trialRelease capsules creonSpainSurgeryTerm-follow-upTreatmentTriglyceride breath test

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Annals Of Surgery due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2016, it was in position 1/197, thus managing to position itself as a Q1 (Primer Cuartil), in the category Surgery.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 2.66. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 5.03 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 26.68 (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-06, the following number of citations:

  • WoS: 54
  • Scopus: 96
  • Europe PMC: 38
  • OpenCitations: 98

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-06-06:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 128.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 128 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 42.95.
  • The number of mentions on the social network Facebook: 1 (Altmetric).
  • The number of mentions on the social network X (formerly Twitter): 64 (Altmetric).

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Italy; Netherlands; Sweden; United Kingdom.