Wasielica-Berger J, Długosz J W, Łaszewicz W, Baniukiewicz A, Werpachowska I, Mroczko B, Dabrowski A
Department of Gastroenterology and Internal Medicine, Medical University of Białystok, Poland.
Adv Med Sci. 2007;52:222-7.
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.
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.
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.
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.
据估计，胆道疾病中胰腺外分泌功能不全的发生率约为30%。本研究旨在评估内镜治疗前后胆道疾病（胆石症、狭窄）患者的胰腺外分泌功能。
对28例胆总管结石及其并发症患者（19例女性/9例男性；年龄31 - 90岁，中位数：69岁）进行评估。在内镜治疗前、早期以及治疗后6 - 8周，采用酶联免疫吸附测定法（ELISA）检测粪便弹性蛋白酶1浓度。同时评估胰腺对治疗的炎症反应。
患者初始粪便弹性蛋白酶1浓度（中位数454μg/g）与对照组（中位数357μg/g）相比无显著差异。9例患者（32%）粪便弹性蛋白酶1浓度较低（低于250μg/g），其中6例低于200μg/g，提示胰腺外分泌功能受损。82%的患者内镜治疗成功。仅1例患者出现胰腺炎症反应。治疗后6 - 8周，全组患者粪便弹性蛋白酶1浓度与初始水平相比无显著变化。然而，9例初始粪便弹性蛋白酶1浓度较低（中位数191μg/g）的患者中，至少6例胰腺功能得到改善（中位数310μg/g），P < 0.001。
三分之一的胆道疾病患者粪便弹性蛋白酶1浓度较低，提示胰腺功能障碍。在这些患者中，至少三分之二的患者成功接受内镜治疗胆道疾病后，粪便弹性蛋白酶1浓度显著升高。因此，这种治疗对部分患者的额外积极作用可能是改善胰腺外分泌功能障碍。
