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Long-term treatment outcomes of oral B12 supplementation in pediatric patients with B12 deficiency following ileal enterocystoplasty
Alison Keenan, MD, Benjamin Whittam, MD, Konrad Szymanski, MD, Shelly King, NP, Rosalia Misseri, MD, Martin Kaefer, MD, Richard C. Rink, MD, Mark Cain, MD.
Indiana University School of Medicine, Indianapolis, IN, USA.
Vitamin B12 deficiency is a known complication of ileal enterocystoplasty, with the incidence of B12 deficiency increasing with longer follow-up. In our previously reviewed series of 128 patients status post ileal enterocystoplasty, 36 patients were identified with low to low normal serum B12 levels. Oral replacement therapy was initiated and demonstrated an excellent short-term success rate of 97% normalization (4 months mean follow-up, J Urology, 2010). We hypothesized that long-term treatment with B12 replacement in this patient population would remain durable and effective.
METHODS: In our previously reviewed series of 128 patients status post ileal enterocystoplasty, 36 patients were identified with low to low normal serum B12 levels. The medical records from these patients were reviewed. We included only patients with multiple serum B12 levels. Patients were followed with yearly office visits and labs, including CBC, serum B12, and BMP. Low serum B12 was defined as ≤ 200 pg/mL, and low normal was defined as 201-300 pg/mL. Patients with serum B12 of <100 pg/mL were referred to neurology and initiated on oral replacement therapy with 250 mcg daily.
RESULTS: 25/36 patients had documented follow-up with multiple B12 levels with a mean follow-up of 49 months (5-85 months). Of these 25 patients, 9/25 (36%) had normal serum B12 levels on most recent follow-up. 16/25 (64%) patients, initially started on B12 oral therapy, on last follow-up had low or low normal serum B12 levels. No patients suffered sequela of B12 deficiency.
We have previously reported that oral vitamin B12 replacement therapy was successful in treating B12 deficiency in patients who are status post ileal enterocystoplasty. However on long-term review these outcomes do not appear durable. When B12 deficiency is identified following enterocystoplasty and treated with oral supplementation, serum B12 levels return to normal in the short term, but were not sustained long term in a closely monitored patient population. Whether this is due to treatment failure or poor compliance to oral medication is unknown. We suggest patients identified to have low serum B12 levels should be initiated on intramuscular injections instead of oral supplementation.
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