409 A Systematic Review of Pancreatic Enzyme Replacement Therapy Use in Acute Pancreatitis - Time to Re-Focus?

Abstract Aim Pancreatic enzyme insufficiency (PEI) is common following pancreatic resection and in patients with chronic pancreatitis. There is increasing recognition that it also occurs in some patients with acute pancreatitis (27-62%). Untreated, it can cause substantial harm. Usual treatment is pancreatic enzyme replacement therapy (PERT), though its benefit in AP patients is uncertain, and guidance on its diagnosis and management is lacking. This review aimed to assess the current literature on PERT use in AP. Method A systematic review of PUBMED and Embase was performed to identify studies reporting PERT use during or after AP. Data extracted included study-characteristics, PERT-usage rates/regimens, reported benefits/harms, follow-up duration, and GRADE-scoring. A narrative synthesis and pooled analysis were conducted. Results Of 2,091 screened records, 28 studies from 13 countries met inclusion criteria. Three RCTs compared PERT to placebo post-AP, but heterogeneity in outcome measures prevented meta-analysis. Among remaining studies (n=25), with variable study-type, follow-up, severity, and aetiology, pooled PERT prescription rate after index episode was 23.7% (95%CI:16.3–32.0%). Only 4 of 25 studies reported PERT-related outcomes, preventing formal synthesis. Table 1 summarises PERT-related outcomes. GRADE scoring showed 14 studies had a ‘very low’, 9 ‘low’, and 5 ‘moderate’ certainty of evidence. Conclusions PEI is a known sequela of AP, but a clear diagnostic and treatment pathway remains undefined. Current evidence is of insufficient quality to guide PERT use in this setting. A rigorously designed prospective study is urgently needed to define the role of PERT during both the index episode and follow-up of AP.