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Can We Predict Postoperative Pancreatic Leakage After Pancreaticoduodenectomy Using Preoperative Fecal Elastase-1 Level?

Authors
 Hyun Wook Shin  ;  Jae Keun Kim  ;  Joon Seong Park  ;  Dong Sup Yoon 
Citation
 JOURNAL OF CLINICAL LABORATORY ANALYSIS, Vol.27(5) : 379-383, 2013 
Journal Title
JOURNAL OF CLINICAL LABORATORY ANALYSIS
ISSN
 0887-8013 
Issue Date
2013
MeSH
Duodenum/surgery ; Exocrine Pancreatic Insufficiency/diagnosis ; Feces/enzymology* ; Female ; Humans ; Male ; Middle Aged ; Pancreas/surgery ; Pancreatic Elastase/analysis* ; Pancreatic Fistula/classification ; Pancreatic Fistula/diagnosis ; Pancreatic Function Tests/methods ; Pancreaticoduodenectomy/adverse effects* ; Postoperative Complications/prevention & control* ; gamma-Glutamyltransferase/analysis*
Keywords
fecalelastase-1 ; pancreatic leakage ; pancreatic texture ; pancreaticoduodenectomy
Abstract
INTRODUCTION:
The measurement of fecal elastas-1 in stools is a sensitive and relatively inexpensive noninvasive test. The aim of this study was to study fecal elastase levels in patients who develop pancreatic leakage after pancreaticoduodenectomy (PD) to determine if fecal elastase level can be used to predict patients at high risk for pancreatic leakage after PD.
METHODS:
Pancreatic function was considered normal when fecal elastase-1 concentration exceeded 200 μg/g feces and moderately or severely insufficient when fecal elastas-1 concentration was less than 200 μg/g feces.
RESULTS:
Of 123 patients who underwent PD, 67 (54.5%) showed fecal elastase-1 levels less than 200 μg/g, indicating moderate or severe pancreatic insufficiency. Pancreas texture, pathology origin, and level of γ-glutamyl transferase (r-GT) were significantly correlated with fecal elastas-1 level. On univariate analysis, the incidence of pancreatic leakage was significantly greater in the group with normal fecal elastase-1 level (≥200 μg/g), pathologic origin (bile duct/ampulla/duodenum), and soft pancreas texture. In multivariate analysis, normal fecal elastase-1 level (≥200 μg/g) and soft pancreatic texture were identified as independent factors for pancreatic leakage.
CONCLUSIONS:
Fecal elastase-1 is the most simple and objective method for predicting pancreatic leakage after PD.
Full Text
http://onlinelibrary.wiley.com/doi/10.1002/jcla.21614/abstract
DOI
10.1002/jcla.21614
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jae Keun(김재근)
Park, Joon Seong(박준성) ORCID logo https://orcid.org/0000-0001-8048-9990
Yoon, Dong Sup(윤동섭) ORCID logo https://orcid.org/0000-0001-6444-9606
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/88193
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