title: Can we predict postoperative pancreatic leakage after pancreaticoduodenectomy using preoperative fecal elastase-1 level?
abstract: BACKGROUND
  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.
authors.affiliation: Pancreatobiliary Cancer Clinic, Department of Surgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Hyun Wook
authors.initials: HW
authors.lastname: Shin
authors.forename: Jae Keun
authors.initials: JK
authors.lastname: Kim
authors.forename: Joon Seong
authors.initials: JS
authors.lastname: Park
authors.forename: Dong Sup
authors.initials: DS
authors.lastname: Yoon
mesh_terms: D004386:Duodenum / Q000601:surgery; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis; D005243:Feces / Q000201:enzymology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery; D010196:Pancreatic Elastase / Q000032:analysis*; D010185:Pancreatic Fistula / Q000145:classification / Q000175:diagnosis; D010186:Pancreatic Function Tests / Q000379:methods; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000517:prevention & control*; D005723:gamma-Glutamyltransferase / Q000032:analysis*
chemical_list: D005723:gamma-Glutamyltransferase; D010196:Pancreatic Elastase
keywords: fecalelastase-1; pancreatic leakage; pancreatic texture; pancreaticoduodenectomy
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