Stool Elastase Level Research Articles

Stool Elastase as an Independent Prognostic Factor in Patients with Pancreatic Head Cancer.

(1) Background: Patients with pancreatic exocrine insufficiency (PEI) have an increased risk of malnutrition, which in turn increases morbidity and mortality and is frequent in pancreatic head cancer. This study aimed to analyze the utility of PEI measured using the stool elastase (SE) level to predict the prognosis of patients with pancreatic head cancer. (2) Methods: Patients who underwent pancreaticoduodenectomy for pancreatic cancer at our institution between 2011 and 2015 were included. Only patients with data on preoperative SE levels were analyzed. Patients were classified into low and high SE groups based on preoperative SE levels (low < 100 µg/g < high). (3) Results: The median preoperative SE level was 67.2 µg/g, and 84 of 143 (58.7%) patients were included in the low SE group. The two groups had significantly different overall survival (OS) and disease-free survival (DFS), and the low SE group had a worse prognosis. In multivariate analysis, SE level < 100 µg/g and lymph node metastasis were independent poor prognostic factors for OS and DFS. (4) Discussion: PEI measured using SE levels is an independent prognostic factor in patients with pancreatic head cancer undergoing pancreaticoduodenectomy. Since poor nutritional status may be related to prognosis in patients with low levels of stool elastase preoperatively, aggressive treatment may be required.

Risk factors deteriorating severe exocrine pancreatic insufficiency measured by stool elastase after pancreatoduodenectomy and the risk factors for weight loss.

PurposeThe measurement of stool elastase (SE) level is useful for evaluating pancreatic exocrine function. This study aimed to determine the risk factors for severe exocrine pancreatic insufficiency (EPI) after pancreatoduodenectomy (PD), and analyze serial changes in nutritional markers and weight based on the SE level.MethodsAmong patients who underwent PD for periampullary disease, patients whose preoperative and postoperative SE levels were measured were included in the study. The deteriorated (exocrine function) group comprised patients whose SE levels decreased from ≥100 µg/g preoperatively to <100 µg/g postoperatively. Patients whose weight 12 months postoperatively was greater than that 3 months postoperatively were classified into the weight-recovery group.ResultsOf the 202 included patients, the deteriorated group had a higher incidence of preoperative SE level above 200 µg/g, benign pathology, and the presence of a clinically relevant postoperative pancreatic fistula than the maintained group. Patients who did not undergo weight recovery had a higher rate of history of adjuvant radiotherapy compared to the no-recovery group.ConclusionThe evaluation of EPI by measuring SE alone is not sufficient because it does not reflect the nutritional status of patients, and a comprehensive approach that considers other parameters is required for EPI management.

Ivacaftor in Omani children with cystic fibrosis caused by p.Ser549Arg CFTR mutation.

BackgroundCystic fibrosis (CF) is a multisystemic chronic disease caused by mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein. These mutations are classified in to six classes. Ivacaftor is a CFTR potentiator which partially restores the CFTR function for class III mutations. In Oman, p.Ser549Arg (class III) is the most common mutation (65% of cases). Our study prospectively evaluated the tolerance and clinical efficacy of ivacaftor.MethodsA prospective observational study was conducted at the Royal Hospital, Oman. All children aged 6–18 years who are followed and carry at least one copy of the p.Ser549Arg mutation were started on Ivacaftor and included in the study. Data collected included weight, height, forced expiratory volume in first second (FEV1), sweat chloride concentration, stool elastase level and liver enzymes at baseline and at 12, 24, 36, and 48 weeks after initiation of treatment. The number of CF pulmonary exacerbations one year before and during treatment were compared.ResultsTwenty one children were started on Ivacaftor (90% homozygous for p.Ser549Arg). The mean age was 10.8 (SD ±3.5) years. When compared to baseline, FEV1 significantly improved by a mean of 10.8 (SD ±13.5) percentage points (pp) and 14.3 (SD ±7.5) pp at 12 and 48 weeks respectively. The sweat chloride level significantly dropped from a mean of 107 (SD ±8.5) mmol/l to 38.5 (SD ±22.3) mmol/l at 12 weeks and remained low. The Body Mass Index (BMI) improved by a mean of 1.37 (SD ±1.3) kg/m 2 and 1.9 (SD ±1.35) kg/m 2 at 24 and 48 weeks of treatment respectively. The number of admissions the year before and during treatment reduced significantly from a mean of 2.2 (SD± 1.9) to 0.7 (SD ±1) admission per year. Two children developed transaminitis.ConclusionIvacaftor is well tolerated and resulted in a significant improvement in FEV1, BMI and sweat chloride level in children with p.Ser549Arg CFTR mutation.

Stool elastase as an independent prognostic factor in patients with pancreatic head cancer

In pancreatic cancer, pancreatic exocrine insufficiency (PEI) is found in 44.5%, is more common in pancreatic head cancer. Patients with PEI have an increased risk of malnutrition, which in turn increases morbidity and mortality. The aim of this study was to analyze the prognosis according to the PEI measured by Stool elastase (SE) level in patients with pancreatic head cancer. Patients who underwent pancreaticoduodenectomy due to pancreatic cancer at Seoul National University Hospital from 2011 to 2015 were included. Among these patients, the patients who had the preoperative SE level were analyzed. Groups were classified based on 100 µg/g, which can be defined as severe PEI. Total 143 patients were included. Median preoperative stool elastase level was 67.2 µg/g. 84 patients (58.7%) were in the low SE group and 59 patients (41.3%) were in the high SE group. There were no significant difference in R0 resection rate, final pathologic stages and adjuvant treatment between the two groups. The two groups had significantly different overall survival (OS) and disease-free survival (DFS), and low SE group had a worse prognosis (median OS: 17 versus 25 months, p = 0.035, median DFS: 8 versus 14 months, p = 0.006). On multivariate analysis, stool elastase ≥ 100 µg/g (hazard ratio (HR): 1.487, p = 0.048), and no lymph node metastasis (HR: 1.852, p = 0.005) were found to be independent prognostic factors for better OS. And those were also significant prognostic factor for DFS. PEI measured by SE level is an independent prognostic factor for patients with pancreatic head cancer who undergoing pancreaticoduodenectomy. In these patients, management of severe PEI such as nutritional support is expected to be required.

The risk factors influencing severe pancreatic exocrine insufficiency measured by stool elastase after pancreatoduodenectomy

Pancreatic exocrine insufficiency after pancreatectomy affects clinical outcomes of patients in postoperative course. This study aimed to analyze risk factors influencing severe pancreatic exocrine insufficiency (PEI) after pancreaticoduodenectomy measured by patient's stool elastase (SE) level. Among patients who received pancreaticoduodenectomy in Seoul National University Hospital from October 2007 through February 2013, patients who measured both preoperative and postoperative SE level were included. Deteriorated (exocrine function) group was defined as patients who decreased from 100 µg/g or more preoperatively to less than 100 µg/g postoperatively. Of 202 included patients, 135 patients were deteriorated group and 67 patients were maintained group. Patients in deteriorated group had higher preoperative stool elastase level (309.6 vs. 143.0, p < 0.001), benign diseases (26.7% vs. 13.4, p = 0.033), presence of clinically relevant postoperative pancreatic fistula (19.3% vs. 7.5%, p = 0.029) compared to maintained group. Postoperative weight showed the lowest at postop 3 months and recovery at 12 months. Weight change in postop 3 months was significantly different between two groups (-4.6 vs. -3.5, p = 0.045). Patients who did not recover their weight of postop 3 months at postop 12 months had higher portion of adjuvant radiotherapy, presence of postoperative pancreatic fistula and high grade of complication compared to recovery group. Those with benign diseases and clinically relevant postoperative pancreatic fistula have a tendency of marked deterioration of pancreatic exocrine function after pancreatoduodenectomy. Therefore physicians should pay attention to support PEI in those with risk factors such as monitoring of exocrine function and optimal enzyme supplements.

Comparison of changes in nutritional status, pancreatic function and quality of life according to gender after pancreatectomy

To compare and analyze changes in nutritional status, pancreatic function and quality of life (QoL) according to gender after pancreatectomy. Patients undergoing pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) between 2007 and 2013 were included. Data on relative body weight (RBW); triceps skinfold thickness (TSFT); body mass index (BMI); serum protein, albumin, transferrin, fasting blood glucose, postprandial 2-h glucose, and stool elastase levels; and QoL questionnaire scores were collected serially for 5 years. RBW, TSFT, and BMI showed similar patterns of change between male and female patients. Biochemical parameters recovered to preoperative values 3 months after surgery in both groups. There was no significant difference in the incidence of diabetes mellitus or impaired fasting glucose between men and women during the follow-up period except for 6 months after surgery. Stool elastase levels showed similar patterns in the two groups from 12 months after surgery. Male patients scored relatively higher than female patients on the EORTC QLQ-C30 questionnaire. There was a significant difference in global health status/QoL between the two groups at 6 and 12 months after surgery and female gender was an independent risk factor for low global health status/QoL in a multivariate analysis. In EORTC QLQ-PAN26 questionnaire, female patients showed a relatively slow decrease in symptom scale scores than male patients. Although female patients showed better nutritional status than males after pancreatectomy, the rate of complaining of functional difficulties and surgery-related symptoms was relatively higher than males in quality of life analysis.

Atrophy of remnant pancreas after pancreatoduodenectomy: Risk factors and effects on quality of life, nutritional status, and pancreatic function.

Factors aggravating remnant pancreas atrophy following pancreatoduodenectomy and the effects of atrophy have not been extensively studied. This study aimed to evaluate the clinical factors affecting remnant pancreas atrophy and assess the effects of atrophy on quality of life, nutritional status, and pancreatic exocrine and endocrine functions. Data collected prospectively from 122 patients who completed 12months of follow-up, including computed tomography and the quality-of-life questionnaire, were analyzed. Pancreas volume was measured using a computed tomography volumetry program. Endocrine and exocrine functions were evaluated. Malignancy and adjuvant chemoradiotherapy were associated with severity of atrophy. At 12 postoperative months, quality-of-life scores and nutritional indexes were mostly not associated with atrophy, but stool elastase level decreased significantly and incidence of new-onset diabetes mellitus was higher in the severe atrophy group. Postprandial 2-hour blood glucose and glycosylated hemoglobin levels were also higher in this group. Remnant pancreas atrophy was more severe in patients with malignant disease who received adjuvant chemoradiotherapy and was associated with pancreatic exocrine and endocrine functions. More careful monitoring and active management of exocrine and endocrine deficiencies are necessary for patients who underwent pancreatoduodenectomy for malignant disease and received chemoradiotherapy.

Effects of pancreatectomy on nutritional state, pancreatic function, and quality of life over 5years of follow up.

To analyze serial changes in nutritional status, pancreatic function, and quality of life (QoL) over 5years of follow-up after pancreatectomy. Patients undergoing pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) between 2007 and 2013 were included. Data on relative body weight (RBW); triceps skinfold thickness (TSFT); body mass index (BMI); serum protein, albumin, transferrin, fasting blood glucose, postprandial 2-h glucose, and stool elastase levels; and QoL questionnaire scores were collected serially for 5years. Two hundred and seventeen patients were enrolled, but 79 patients completed the 5-year follow-up. RBW, BMI, and TSFT continued to decrease postoperatively but increased after 6months. Transferrin, albumin, and protein levels recovered to the preoperative level after 3months. Multivariate analysis revealed that a BMI >25 kg/m2 , DP, and adjuvant therapy had a significant impact on endocrine pancreatic insufficiency. Although steatorrhea and diarrhea were mainly resolved by 12months, the stool elastase level decreased after PD and was not restored. The mean scores for all QoL questionnaires improved above the preoperative value at 12months. Patients undergoing pancreatectomy can return to their daily lives after 12months. However, those with risk factors associated with pancreatic function and QoL need more careful follow-up and supportive management.

Genetic and Clinical Features of Shwachman-Diamond Syndrome in Russian Population: Prospective Study

Background. Shwachman-Diamond syndrome (SDS) is the rare genetic autosomal recessive disorder with pathogenic variants in SBDS gene. The spectrum of SBDS gene variants in patients with SDS and features of disease course have not been studied before in Russian population. Objective. The aim of the study was to describe all the variants of SBDS gene and clinical and laboratory abnormalities in children with SDS. Methods. In this prospective study exocrine pancreatic function was estimated by amylase and lipase activity in blood, steatorrhea presence and stool elastase levels during the initial hospitalization. Haematological disorders were analysed by complete blood count. Bone abnormalities were diagnosed via X-ray imaging. Growth delay was established due to anthropometry indicators and percentile curves. Molecular genetic testing was performed with using next generation sequencing and Senger sequencing. Results. Pathogenic variants in SBDS gene (8 in general) were revealed in 25 (89%) out of 28 children with SDS. The most common variant (in 23 patients, 82%) was с.258+2T&gt;C, and in 18 cases it was in compound heterozygous state with c.183_184delTAinsCT. Two patients had с.653G&gt;A (p.Arg218Gln) variant and for one patient for every of the following variants: c.258+1G&gt;A, c.107delT, с.356G&gt;A, c.297_300delAAGA, c.338C&gt;T. All children with SDS had growth delay, in 11 (39%) cases we revealed bone abnormalities. In blood samples of 24 (86%) children we revealed neutropenia and less frequently anemia and thrombocytopenia. The stool elastase I decreased activity (&lt; 200 pg/g) was revealed in 26 (92%) patients. 21 (75%) children had cytolysis syndrome. Conclusion. Pathogenic variants of SBDS gene were revealed in majority of Russian children with SDS. The most frequent are c.258+2T&gt;C and c.183_184delTAinsCT variants. Clinical signs of Shwachman-Diamond syndrome manifest since birth with growth delay, steatorrhea and haematological disorders.

Comparison of long-term clinical outcomes of external and internal pancreatic stents in pancreaticoduodenectomy: randomized controlled study

BackgroundTo determine the most appropriate pancreatic drainage method, by investigating differences in 12-month clinical outcomes in patients implanted with external and internal pancreatic stents as an extension to a previous study on short-term outcome. MethodsThis prospective randomized controlled trial enrolled 213 patients who underwent pancreaticoduodenectomy with duct to mucosa pancreaticojejunostomy between August 2010 and January 2014 (NCT01023594). Of the 185 patients followed-up for 12 months, 97 underwent external and 88 underwent internal stenting. Their long-term clinical outcomes were compared. ResultsOverall late complication rates were similar in the external and internal stent groups (P = 0.621). The percentage of patients with >50% atrophy of the remnant pancreatic volume after 12 months was similar in both groups (P = 0.580). Factors associated with pancreatic exocrine or endocrine function, including stool elastase level (P = 0.571) and rate of new-onset diabetes (P = 0.179), were also comparable. There were no significant between-group differences in quality of life, as evaluated by the EORTC QLQ-C30 and QLQ PAN26 questionnaires. ConclusionExternal and internal stents showed comparable long-term, as well as short-term clinical outcomes, including late complication rates, preservation of pancreatic duct diameters, pancreatic volume changes with functional derangements, and quality of life after surgery.

Influence of preoperative nutritional status on clinical outcomes after pancreatoduodenectomy

BackgroundThis study investigated the clinical outcomes according to the preoperative nutritional status and to identify factors influencing long-term unrecovered nutritional status. MethodsData were prospectively collected from 355 patients who underwent PD between 2008 and 2014. Nutritional status was evaluated by Mini Nutrition Assessment (MNA) and patients were classified into group A (malnourished), group B (risk-of-malnutrition), or group C (well-nourished). MNA score, complications, body mass index (BMI), stool elastase level, biochemical parameters, and quality-of-life (QOL) were collected serially for 1 year. ResultsPreoperatively, 60 patients were categorized into group A, 224 into group B, and 71 into group C. Overall complication and pancreatic fistula were higher in groups A and B compared with group C (P = 0.003 vs P = 0.004). QOL, biochemical parameters, BMI and stool elastase level were lowest in group A preoperatively. BMI and stool elastase level remained low after surgery in all groups. Advanced age, low BMI, pre-existing diabetes mellitus, jaundice, exocrine insufficiency and adjuvant therapy were factors influencing long-term unrecovered nutritional status. ConclusionPreoperative malnourished patients suffer from poor clinical outcomes. Therefore, those with risk factors of malnutrition should be monitored and vigorous efforts are needed to improve their nutrition.

A comparison of transverse and midline incisions for pancreaticoduodenectomy

What impact does pancreaticoduodenectomy (PD) have on exocrine function? Does the pancreatic anastomosis remain patent? When stool elastase became available for testing in November 2001, we began preoperative assessment and then increasingly employed postoperative measurements. From December 2001 until March 2006, 182 patients underwent PD by the same surgeon. Preoperative stool elastase was measured in 138 (76%) patients and was repeated postoperatively at 3 ± 1 month, 12 ± 2 months, and 24 ± 3 months. At the same time periods, an abdominal CT scan was used to assess patency of the pancreatic anastomosis as implied by pancreatic duct dilation in the remnant (dilation = duct >3 mm or, if duct dilated preoperatively, then duct that failed to decrease in size). All cases were reconstructed with duct-to-mucosa pancreaticojejunostomy. Stool elastase was expressed as normal (>200 μg/gram stool), moderately reduced (100–200 μg/gram), or severely reduced (<100 μg/gram). Preoperative stool elastase values were “normal” in 78% (pancreatic cancer 32% normal vs. all other groups >78%; P ≤ 0.001). As compared with preoperative values, the percent of cases with reduced elastase levels at 3 months, 1 year, and 2 years postoperatively was 48%, 73%, and 50%, respectively. The CT scans at the time of the 69 stool elastase measurements after PD showed pancreatic duct dilation in the pancreatic remnant in 9 of 69 (9%) stools but was not more frequent in the group with decreased elastase. Based on cases elastase, one third of patients about to have PD will have exocrine insufficiency, an observation most common among the patients with pancreatic cancer (68%). Stool elastase levels are further depressed in the majority of cases after PD from parenchymal loss because we could not implicate an occluded pancreatic anastomosis. These results suggest that, after PD, exocrine supplementation should be given to all patients with pancreatic cancer, especially those with impending adjuvant therapy. To further improve the long-term results after PD, each surgeon should assess the effect of their own type of pancreaticoenteric technique on exocrine function.

Effects of pancreatectomy on nutritional state, pancreatic function and quality of life

There are concerns about the extent of impaired endocrine and exocrine pancreatic function and poor quality of life (QoL) after pancreatectomy, but there is little information from large prospective follow-up studies. Consecutive patients undergoing pancreaticoduodenectomy or distal pancreatectomy between 2007 and 2011 were included. Relative bodyweight (RBW), triceps skinfold thickness (TSFT), serum protein, albumin, transferrin, fasting blood glucose, postprandial 2-h glucose (PP2), glycosylated haemoglobin A1c and stool elastase measurements, and European Organization for Research and Treatment of Cancer QLQ-C30 questionnaires were collected serially for 1 year. Some 136 patients undergoing pancreatic resection completed the study. RBW and TSFT recovered to over 90 per cent of the preoperative value by 12 months, whereas transferrin, albumin and protein had returned to preoperative levels by 3 months. Diabetes mellitus, impaired fasting glucose or raised PP2 was present in 42 of 76 patients at 6 months and 36 of 76 at 12 months. Although steatorrhoea and diarrhoea had mainly resolved by 3 months, stool elastase level decreased after operation and showed no recovery. Nutritional status, pancreatic endocrine function and QoL returned to preoperative levels in 63 (46·3 per cent), 72 (52·9 per cent) and 77 (56·6 per cent) of 136 patients within 6 months of pancreatectomy. Multivariable analysis revealed that age 60 years or more, operation type, chronic pancreatitis and malignant disease had a significant impact on nutritional index, pancreatic function and QoL. About half of all patients can expect recovery from pancreatectomy after 6 months, but those with risk factors need more careful follow-up and supportive management.

Exocrine Function Following the Whipple Operation as Assessed by Stool Elastase

What impact does pancreaticoduodenectomy (PD) have on exocrine function? Does the pancreatic anastomosis remain patent? When stool elastase became available for testing in November 2001, we began preoperative assessment and then increasingly employed postoperative measurements. From December 2001 until March 2006, 182 patients underwent PD by the same surgeon. Preoperative stool elastase was measured in 138 (76%) patients and was repeated postoperatively at 3 +/- 1 month, 12 +/- 2 months, and 24 +/- 3 months. At the same time periods, an abdominal CT scan was used to assess patency of the pancreatic anastomosis as implied by pancreatic duct dilation in the remnant (dilation = duct >3 mm or, if duct dilated preoperatively, then duct that failed to decrease in size). All cases were reconstructed with duct-to-mucosa pancreaticojejunostomy. Stool elastase was expressed as normal (>200 microg/gram stool), moderately reduced (100-200 microg/gram), or severely reduced (<100 microg/gram). Preoperative stool elastase values were "normal" in 78% (pancreatic cancer 32% normal vs. all other groups >78%; P < or = 0.001). As compared with preoperative values, the percent of cases with reduced elastase levels at 3 months, 1 year, and 2 years postoperatively was 48%, 73%, and 50%, respectively. The CT scans at the time of the 69 stool elastase measurements after PD showed pancreatic duct dilation in the pancreatic remnant in 9 of 69 (9%) stools but was not more frequent in the group with decreased elastase. Based on cases elastase, one third of patients about to have PD will have exocrine insufficiency, an observation most common among the patients with pancreatic cancer (68%). Stool elastase levels are further depressed in the majority of cases after PD from parenchymal loss because we could not implicate an occluded pancreatic anastomosis. These results suggest that, after PD, exocrine supplementation should be given to all patients with pancreatic cancer, especially those with impending adjuvant therapy. To further improve the long-term results after PD, each surgeon should assess the effect of their own type of pancreaticoenteric technique on exocrine function.

ROLE OF FAECAL ELASTASE 1 IN PANCREATIC CANCER: A PILOT STUDY.

Background: Faecal elastase 1 (E1) is an indirect test of pancreatic function. Few study investigated the role of E1 in pancreatic cancer. Aim: 1) To evaluate fecal elastase levels in normal healthy subject in comparison to patients with pancreatic cancer 2) To assess the relationship between faecal elatase 1 and tumor topography in patients with pancreatic cancer. Methods: 26 consecutive patients (15 male, 11 female, mean age 72±21.3) admitted in our G.I. unit between January 2003 and February 2004 with first diagnosis of pancreatic cancer were enrolled in the study. Clinical, laboratory, histologic and imaging data were prospectively collected. Cancer topography was as follow: 14 patients had head cancer; 5 patients had body-tail cancer; 7 patients had head-body cancer. The head-body group of patients was removed from the study when we analized the relationship between fecal elastase levels and pancreatic cancer topography. Control group was composed from 165 normal healthy subject (70 male, 95 female, mean age 68±27.1). All patients and control gave their informed consent. Stool elastase level was measured by an immunoenzymatic method (Meridian Bioscience Europe). According to our normal control group, we considered abnormal E1 values lower than 200 μg/g. Mann-Whitney rank-sum test was used to data analysis. Results: Faecal elastase 1 levels were significantly decreased in pancreatic cancer patients (276.2±234.4) in comparison to normal subjects (504.5±145.3) (p<0.0001). A correlation between E1 levels and cancer topography was found: patients with pancreatic head cancer showed lower E1 levels (189.4±180.7) in comparison to patients with pancreatic body-tail cancer (421.2±229.1) but did not achieve significant level of p (p=0.078) because of low power of the test. Conclusions: Faecal elastase 1 is significantly decreased in patients with pancreatic cancer in comparison to normal healthy subject. Moreover, fecal elastase 1 could have a significant correlation with pancreatic cancer localization.

Organ-preserving pancreatic head resection in chronic pancreatitis.

Twenty to thirty per cent of patients with chronic pancreatitis develop inflammatory enlargement of the head of the pancreas. A safe procedure has been developed for duodenum-preserving pancreatic head resection; this report describes the preliminary results achieved. Thirty patients, 27 men and three women of mean age 44 years, underwent surgical resection following the development of an inflammatory mass in the pancreatic head. All patients had weight loss and frequent abdominal pain. Jaundice was present in three and diabetes mellitus in ten patients. The diagnosis of chronic pancreatitis was made by a combination of endoscopic retrograde cholangiopancreatography, sonography and computed tomography. Pancreatic function was assessed by amylum tolerance test (ATT), oral glucose tolerance test and stool elastase measurement. The surgical procedure involved wide local resection of the inflammatory tumour in the pancreatic head, without division of the pancreas over the portal vein. Reconstruction involved drainage via a jejunal Roux-en-Y loop. In three icteric cases, prepapillary bile duct anastomosis was also performed using the same jejunal loop. There were no hospital deaths or major complications. After a median follow-up of 10 (range 6-14) months, all patients were symptom free. The mean increase in body-weight was 8.9 (range 4-20) kg. The ATT and stool elastase level demonstrated improved exocrine function but there was no change in endocrine function. This type of pancreatic head resection is a safe procedure that provides good short-term relief of symptoms associated with inflammatory changes in the head of the pancreas in chronic pancreatitis.