Bariatric Surgery Linked to Acute Pancreatitis Risk

New research suggests that bariatric surgery, commonly done to help people lose weight and improve other health factors, may increase the risk of acute pancreatitis. 

In a study published in the December issue of Obesity Surgery, researchers from the Cleveland Clinic in Ohio found many patients who underwent different types of bariatric surgery also developed acute pancreatitis.

Researchers followed nearly 2,700 patients who underwent some type of bariatric surgery between January 2004 to September 2011. Patients underwent either Roux-en Y gastric bypass, sleeve gastrectomy, adjustable gastric banding or other procedures.

Out of 2,695 subjects who underwent bariatric surgery, 28 (1.04%) developed acute pancreatitis during a follow-up of three and a half years. One of those patients died of complications associated with acute pancreatitis as a result.

While obesity is seen as a potential factor in the development of acute pancreatitis, the rate seen among bariatric surgery patients was significantly higher than the rate of acute pancreatitis in the general population, researchers noted.

Out of the 28 patients that suffered acute pancreatitis, almost half were determined to have other abnormal findings as well, including a prior history of pancreatitis, gallstones or ductal dilation. Researchers said these abnormalities, and others, could be predictors of whether a bariatric surgery patient was at an increased risk of acute pancreatitis.

Rapid weight loss was one of the key predictors of acute pancreatitis; a significant factor patients are hoping to achieve after undergoing bariatric surgery.

The average body mass index (BMI) before surgery was 47.4, which dropped to 38.3 within an average of one and a half years post-op.

Researchers found that 79% of those who suffered acute pancreatitis underwent gastric banding, also known as the Lap-Band. However, the researchers noted that type of surgery was far more popular than other bariatric surgeries, which could account for why so many cases were associated with it.

A study published late last year revealed gastric bypass surgery offers patients more weight loss, but is also more likely to cause complications. In fact, patients who underwent gastric banding lost twice the amount of weight as other bariatric surgeries, but experienced higher risks of short term complications and long-term hospitalizations.

Another consideration researchers discussed was the factor of chronic low-grade inflammation caused by obesity. This can put patients at risk for developing more severe acute pancreatitis. Often inflammatory markers do not decrease after surgery for six to 24 months.

Alcohol induced pancreatitis was not seen during the study, but researchers admitted alcohol use may be an under-recognized cause of acute pancreatitis. One patient who denied alcohol use and developed acute pancreatitis was later treated for alcohol dependence one year later.

Increasing Obesity Leading to More Surgeries

The prevalence of obesity in the U.S. reached nearly 36% in 2010 with the frequency of bariatric surgeries becoming increasingly common. Researchers estimate 53 procedures were conducted per 100,000 adults in 2008.

The American Medical Association officially named obesity as a recognizable disease in 2013.

More than 150,000 people will elect to undergo some form of bariatric surgery each year. With advancements in surgery, the mortality rate dropped to 0.1%. However, a study published in 2011 highlighted a large number of serious complications following bariatric surgery. Researchers found side effects of weight loss surgery can include malnutrition, vision problems, vitamin deficiencies and other serious complications.

More procedures can mean more complications. A study published in October of last year concluded bariatric surgery can lead to reduced long-term survival rates, risks of microvascular and macrovascular events and negative mental health outcomes.

“Because of the growing recognition of obesity as a disease and the increasing number of bariatric surgeries, it is vital to understand potential complications in this patient population,” the researchers determined.

Researchers say it is important to have careful follow-up with radiological monitoring if bariatric surgery patients show warning factors for acute pancreatitis.