[Pancreatic elastase-1 in the stool for the determination of exocrine pancreas function of postoperative patients with early enteral nutrition -- a pilot study].
OBJECTIVE
There are only incomplete data about exocrine pancreatic function after major gastrointestinal surgery. Early enteral nutrition with high-molecular diets is increasingly administered to these patients. A knowledge of exocrine secretion of the pancreas is crucial, because pancreatic enzymes are needed for the adsorption of the high-molecular diets. To determine the exocrine pancreatic secretion the fecal elastase-1 is a sensitive method for measuring exocrine pancreatic secretion.


METHODS
In a prospective study fecal elastase-1 was measured in patients on enteral nutrition (n=12) early after major gastrointestinal operations. They were given a high molecular diet via an intraoperatively placed small-needle catheter jejunostomy, starting 12 hours after operation with a continuous infusion of 20 ml/h (1 kcal/ml),increased to 80 ml/h during the next few days. Samples from the first and second stools after beginning the enteral nutrition were taken for measuring the fecal elastase-1.


RESULTS
All patients fed enterally had no relevant feeding-associated complications and no diarrhea. The elastase-1 concentrations were normal in both the first and the second stool samples in all patients (normal stool elastase is > 200 g/g). The average elastase concentration in the first stool sample was 361,4 mg/g (median: 317 mg/g) and 454 mg/g in the second (median: 466,6 mg/g). Thus no exocrine pancreatic insufficiency was detected in any of the patients.


CONCLUSIONS
The results of elastase-1 in stool demonstrate that severe exocrine pancreas dysfunction is not generally present in patients on early enteral nutrition after major gastrointestinal surgery.
Senkal
M
M
Chirurgische Klinik der Ruhr-Universität Bochum, St. Josef Hospital. Senkal@Marien-Hospital-Witten.de
Marpe
B
B
Deska
T
T
Zumtobel
V
V
Adolph
M
M
D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition / Q000379:methods*; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis / Q000201:enzymology; D005243:Feces / Q000201:enzymology*; D005260:Female; D041981:Gastrointestinal Tract / Q000601:surgery*; D006801:Humans; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D046790:Pancreas, Exocrine / Q000502:physiology*; D010196:Pancreatic Elastase / Q000032:analysis*; D010865:Pilot Projects; D011182:Postoperative Care; D011446:Prospective Studies; D013997:Time Factors
D010196:Pancreatic Elastase