Exocrine pancreatic function in biliary tract pathology treated with the endoscopic methods.
OBJECTIVE
Incidence of pancreatic exocrine insufficiency in biliary pathology is estimated for about 30%. The objective was to assess pancreatic exocrine function in biliary tract pathology (cholelithiasis, strictures) before and after endoscopic treatment.


METHODS
Twenty-eight patients with choledocholithiasis and its complications (19F/9M; aging 31-90 years, median: 69 years) were evaluated. Fecal elastase 1 concentration was measured using ELISA, before, early, and 6-8 weeks after endoscopic treatment. The inflammatory response of pancreas to the treatment was also assessed.


RESULTS
Initial fecal elastase 1 concentration in patients (median 454 microg/g) was not significantly different as compared to the control (median 357 microg/g). Nine patients (32%) had low fecal elastase 1 concentration (below 250 microg/g) and out of them 6 had the concentration below 200 microg/g, suggesting impairment of exocrine pancreatic function. Endoscopic treatment was successful in 82% of patients. Pancreatic inflammatory response was noted only in one patient. After 6-8 weeks fecal elastase 1 concentration in the whole group of patients did not significantly change in comparison to the initial level. However, out of 9 patients with initially low fecal elastase 1 concentration (median 191 microg/g) at least in 6 pancreatic function improved (median 310 microg/g), P < 0.001.


CONCLUSIONS
One third of the patients with biliary pathology had a low fecal elastase 1 concentrations, suggesting pancreatic dysfunction. In at least 2/3 of these patients successful endoscopic treatment of biliary pathology resulted in the significant increase of fecal elastase 1 concentration. Therefore, an additional positive effect of such treatment in some patients, could be an improvement of the exocrine pancreatic dysfunction.
Wasielica-Berger
J
J
Department of Gastroenterology and Internal Medicine, Medical University of Białystok, Poland.
Długosz
J W
JW
Łaszewicz
W
W
Baniukiewicz
A
A
Werpachowska
I
I
Mroczko
B
B
Dabrowski
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000378:metabolism; D000469:Alkaline Phosphatase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001652:Bile Ducts / Q000473:pathology; D001659:Biliary Tract / Q000473:pathology*; D001663:Bilirubin / Q000378:metabolism; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D020347:Lithiasis; D008297:Male; D008875:Middle Aged; D046790:Pancreas, Exocrine / Q000502:physiology*; D010196:Pancreatic Elastase / Q000097:blood / Q000378:metabolism; D000516:alpha-Amylases / Q000378:metabolism
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D000516:alpha-Amylases; D010196:Pancreatic Elastase; D001663:Bilirubin