Evaluation of pancreatic enzyme insufficiency with fecal elastase levels before and after Sleeve Gastrectomy in morbidly obese patients

Aim: The aim of this study is to detect changes in pancreatic functions following Laparoscopic Sleeve Gastrectomy (LSG) using the Fecal Elastase-1 (FE-1) test. Material and Method: Sixty patients were included in the study. Stool samples were collected preoperatively and at the sixth month postoperatively, stored at -80°C. After all samples were obtained, FE-1 levels were measured using the Enzyme-Linked Immunosorbent Assay (ELISA) method. Results were statistically analyzed. The effect of LSG on Pancreatic Exocrine Insufficiency (PEI) was investigated by comparing pre- and postoperative values. Results: The mean age of the patients was 34.2 ± 11.3 years. The preoperative mean Body Mass Index (BMI) was 44.7 ± 5.1 kg/m², which decreased to 31.6 ± 4.8 kg/m² at the sixth postoperative month (p < 0.001). The mean % Excess Weight Loss (EWL) at six months was 72.3 ± 16.5%. The mean FE-1 level was 202.4 ± 84.5 μg/g prior to LSG, which increased to 256.8 ± 77.3 μg/g six months after LSG. This increase was statistically significant (Z = -3.1, p = 0.002). Preoperatively, severe PEI (0–99 μg/g) was detected in 2 patients (3.3%), mild PEI (100–199 μg/g) in 29 patients (48.3%), and no PEI in 29 patients (48.3%). At six months post-LSG, the two patients with severe PEI showed partial improvement, with FE-1 levels rising to mild PEI ranges. Among the 29 patients with mild PEI preoperatively, FE-1 levels normalized (≥200 μg/g) in 17 (58.6%), while mild PEI persisted in 12 (41.4%). Conclusion: A significant increase in FE-1 levels and improvement in PEI were observed six months after LSG in morbidly obese patients Key Words: Exocrine pancreas, gastrectomy, pancreatic elastase I