- Email: [email protected]
Giardiasis with a lesion of the pancreas
S42
Abstracts / Pancreatology 13 (2013) S2–S98
Results: Although 15 patients (75%) had Grade A PF, clinically relevant Grade B PF was found in only 4 patients (20 %). Moreover, there were no patients with Grade C PF and/or surgery-related mortality. As for risk factors, univariate analysis revealed that compression thickness of pancreatic stump divided by the stapler alone was a significant risk factor. Conclusion: The incidence rate of clinically relevant PF after DP is relatively low as previous reports showed. The most important risk factor for PF was considered to be the thickness of the pancreatic stump.
PI-80 Abstract id: 22.
- Chronic pancreatitis is a well known entity throughout history. - Alcohol consumption in 17th Italy century was intemperate; especially wine consumption was higher than nowadays. Conclusion: In conclusion, possible alcohol abuse and resulting € ng to chronic pancreatitis of Zuane Viaro could have enabled Wirsu discover the pancreatic duct at the autopsy.
PI-82 Abstract id: 126.
Solid tumors of the pancreas can put on a mask through cystic change
Total gastropancreatectomy with portal vein resection for giant renalcell cancer metastases into the pancreas: a report of two cases
Kwang Yeol Paik 1, Seong Ho Choi 2, Jin Seok Heo 2, Dong Wook Choi 2.
Vladimir Lyadov, Zakhar Kovalenko, Valerii Egiev.
1
Yeouido St.Mary’s Hospital, South Korea 2 Samsung Medical Center, South Korea Introduction: Solid pancreatic tumors such as pancreatic ductal adenocarcinoma (PDAC), solid pseudopapillary tumor (SPT), and pancreatic endocrine tumor (PET) may occasionally manifest as cystic lesions. Aims: In this study, we have put together our accumulated experience with cystic manifestations of various solid tumors of the pancreas Patients & methods: From 2000 to 2006, 376 patients with pancreatic solid tumor resections were reviewed. Ten (2.66%) of these tumors appeared on radiological imaging studies as cystic lesions. We performed a retrospective review of medical records and pathologic findings of these 10 cases. Results: Of the ten cases in which solid tumors of the pancreas manifested as cystic lesions, six were PDAC with cystic degeneration, two were SPT undergone complete cystic change, one was cystic PET, and one was a cystic schwannoma. The mean tumor size of the cystic portion in PDAC was 7.3 cm, and three patients were diagnosed as ’pseudocyst’ with or without cancer. Two SPT were found incidentally in young women and were diagnosed as other cystic neoplasms. One cystic endocrine tumor was preoperatively suspected as intraductal papillary mucinous neoplasm or mucinous cystic neoplasm. Conclusion: Cystic changes of pancreas solid tumors are extremely rare. However, the possibility of cystic manifestation of pancreas solid tumors should be kept in mind.
PI-81 Abstract id: 136.
State Medical and Rehabilitation Center, Russia Introduction: Renal-cell cancer metastases into the pancreas are relatively common. However, total gastropancreatectomy has not yet been reported in patients with giant renal-cell cancer metastases into the pancreas. Aims: To present the results of two total gastropancreatectomies for giant renal-cell cancer metastases into the pancreas. Patients & methods: Both patients were 61 and 64-years old male. Patient one presented 14 years after left nephrectomy for renal-cell cancer with diabetes, anemia and a 17 cm mass, involving entire pancreas, stomach and portal vein with a thrombus. Three small lung lesions were also found. Patient two presented 12 years after right nephrectomy for cancer with a solitary 12 cm pancreatic mass with portal vein, splenic vessels, left gastric artery and colonic mesentery involvement. Results: Patient one underwent total gastropancreatectomy with portal vein resection, thrombectomy and prosthetic repair and was discharged on post-operative Day 12 to get targeted therapy. Patient two had total gastropancreatectomy, portal vein and colon resection. Colonic anastomotic leak with multi-organ failure developed leading to ileostomy and 70 days of hospital stay. Despite the absence of cancer progression and massive enzyme substitution in both cases severe malnutrition developed necessitating frequent institutionalization. Patient one died from myocardial infarction 9 months after surgery. Patient two is alive 10 months after surgery, however, cachectic and receiving semi-elemental enteral nutrition. Conclusion: Total gastropancreatectomy with portal vein resection is a technically feasible and might be prognostically favorable procedure in giant renal-cell metastases into the pancreas. However, it leads to severe malnutrition and necessitates intensive follow-up and nutritional support.
Was the Wirsung duct discovery facilitated by intemperate alcohol consumption in 17th century Italy? Filip Cecka, Bohumil Jon, Milan Kaska. love , Czech Republic University Hospital Hradec Kra € ng (1589-1643) is very Introduction: The story of Johann Georg Wirsu € ng discovered the well known. Much has been written about his life. Wirsu pancreatic duct on March 2nd, 1642 during an autopsy of Zuane Viaro Della Badia, a 30-year-old murderer who had been hanged the day before. Instead of publishing his discovery, he engraved a drawing of the duct on a copper plate, from which he made at least seven imprints. The copies were € ng was sent to leading anatomists of Europe to obtain their opinion. Wirsu shot to death on August 22nd, 1643; conflict over the discovery of the duct was suggested as the most probable reason for the assassination. The story € ng is fascinating in itself. However, other circumstances of the of Wirsu discovery attracted our attention. Aims: Our main hypothesis is that Zuane Viaro suffered from chronic pancreatitis. Patients & methods: Several facts support this hypothesis: Results: - The main pancreatic duct in a healthy pancreas is frequently difficult to find even if we know what we are searching for. Chronic pancreatitis with main pancreatic duct dilatation could have facilitated the discovery.
PI-83 Abstract id: 9. Giardiasis with a lesion of the pancreas Natalya Gubergrits, Galina Lukashevich. Donetsk National Medical University n. a. M. Gorky, Ukraine Introduction: Lamblias may have a direct pancreotoxic effect by the penetrating into the parenchyma of the pancreas and causing the development of pseudotumor-like pancreatitis (I. Nakano et al., 1995). There’s a possible risk of development of the exocrine pancreatic insufficiency and diabetes mellitus (T. Miyahara et al., 1997). Aims: To evaluate the exocrine pancreatic function in patients with chronic pancreatitis and girardiasis. Materials & methods: The study included 28 patients with chronic pancreatitis and giardiasis. Diagnosis was confirmed by the presence of antibodies in the blood. Specific antigen GSA 65 was detected in the stool. All patients underwent fecal elastase test (with a lyophilization of feces) and sonography. Two patients with pseudotumor-like pancreatitis underwent percutaneous trepanobiopsy of the pancreas.
Abstracts / Pancreatology 13 (2013) S2–S98
Results: Such peculiarities of the clinical chronic pancreatitis in patients with giardiasis as the apparent asthenic syndrome, aching moderate abdominal pain attracted our attention. According to the sonography, pseudotumor-like pancreatitis occurred in 15 (53.6%) patients. Lamblias were detected in the tissue of the pancreas of 2 patients who underwent a biopsy of that organ. In accordance with the results of fecal elastase test, severe pancreatic insufficiency was detected in 5 (17.8%) patients, moderate and mild insufficiency were identified in 7 (25.0%) and 8 (28.6%) patients respectively. Normal levels of fecal elastase-1 were defined in 8 (28.6%) patients. Conclusion: Patients with giardiasis have pancreatic insufficiency in almost 3/4 of cases, and more than half of them have pseudotumor-like variant of the chronic pancreatitis.
PI-84 Abstract id: 287. Massive gastrointestinal bleeding in an 82nd day-post pancreaticoduodenectomy patient caused by a portoenteric fistula and complicated by a Meckel’s diverticulum: A case report Marc Gil Marcelo, Ericson Berberabe, Ramon de Vera. Philippine General Hospital, Philippines Introduction: Post-PD hemorrhage occurs in 2-15% of all patients. Aims: We report an unusual cause of gastrointestinal bleeding three months after pancreaticoduodenectomy Patients & methods: SP, 50/M, underwent PPPD for ampullary adenocarcinoma. Pancreaticojejunostomy was done using duct/mucosa technique. Patient had an unremarkable post-operative course and was discharged on 7th POD. Results: On 82nd POD, he had episodes of melena/hematochezia. He underwent UGI endoscopy. Scope was inserted 20 cms into efferent limb, 10 cms into afferent limb. No note of any active bleeding nor recent bleed. Colonoscopy revealed blood clots at cecum with no masses, polyps or diverticulum. At ICU, while awaiting for angiogram, patient had melena/hematochezia with hemodynamic instability. A decision to operate was made. During laparotomy, there was note of Meckels diverticulum 80 cms from ICV. Intraoperative colonoscopy showed clots from rectum to transverse colon without bleeding. Enteroscopy proximal to diverticulum showed visualization of 120 cms of bowel proximal to diverticulum without bleeding. Enterocolonoscopy from diverticulum to ascending colon showed clots without bleeding. Ileal mucosa adjacent to the diverticulum was boggy with superficial erosions. Segmental resection of ileum including the diverticulum with en bloc right hemicolectomy with hand sewn anastomosis was performed. The area of pancreaticoduodenectomy was intact. Conclusion: On second post-operative day, there was recurrence of hematochezia with hypotension. Repeat laparotomy showed blood-filled small bowels and stomach. Entetomy of afferent limb showed a connection between the jejunum and portal vein. All anastomoses were intact. There were no signs of inflammation. The patient went into CP arrest during exploration and was not revived.
PI-85 Abstract id: 51. Pancreaticobiliary ductal anatomy in normal population Chumpon Wilasrusmee, Napaphat Proprom. Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
S43
Introduction: The complex anatomy of the pancreaticobiliary duct was crucial in management of pancreatic disease. Aims: To demonstarte the basic data of pancreaticobiliary ductal anatomy. Patients & methods: Fresh specimens of the pancreas were obtained en bloc from the autopsies of 150 patients who had no pancraetic disease. Methylene blue infusion via the pancreatic duct cannulation and careful dissection was performed. Results: Ninety-three male and 67 female patients were included (age 15-78 years). The mean length of the pancreas was 16.2þ/- 1.70 cm (9.820) cm. The intrapancreatic portion of the common bile duct showed patterns of three types; most common 85.30% was type A, in which the anterior surface of the common bile duct was totally covered, while its posterior surface was partially covered, by the pancreatic parenchyma. On dissection of the accessory duct of Santorini, the accessory duct was traceable to the duodenal wall in 67.56%. The anatomy of the Wirsungcholedochus confluence was grouped into five different types. The common channel (junction of the common bile duct and pancreatic duct) was found in 75.60% of specimens and its length varied from just a common junction (so-called "V-type" anatomy) to 15 mm (Y-type-b). Separate papillae (II-type) were found in 15. 72% of specimens. Separate openings in the same papilla (U-type) were found in 13.54% of specimens. The Wirsung duct at the pancreatic neck was most often located posterior and superior in relation to the surface of pancreas. Conclusion: Several important points regarding the anatomy of the pancreaticobiliary junction and pancreatic ductal system were illustrated in this study.
PI-86 Abstract id: 124. Exocrine pancreatic insufficiency in patients with celiac disease Miroslav Vujasinovic 1, Bojan Tepes 2, Sasa Rudolf 3. 1
Department of Internal Medicine; Slovenj Gradec General Hospital, Gosposvetska 1, 2380 Slovenj Gradec, Slovenia 2 Abakus Medico Diagnostic Centre, Prvomajska 29, 3250 Rogaska Slatina, Slovenia 3 Department of Radiology, University Medical Centre Maribor, Ljubljanska 5, Slovenia Introduction: The association between celiac disease (CD) and exocrine pancreatic insufficiency (EPI) was a topic of many researches in which different diagnostic methods were used. Aims: To determine whether exocrine pancreatic function is impaired in patients with CD in our population. We are presenting preliminary results. Patients & methods: Pancreatic exocrine function was determined by the fecal elastase-1 concentration (FEC). Patients were divided into three groups: A - newly diagnosed CD; B - known CD patients on a gluten-free diet (GFD) and C - patients with known CD on a normal diet (those who refused medical advice). Results: There are currently 46 patients included in the study, 34 (73.9%) female and 12 (26.1%) male, mean age 44.417,0 years (range 2076). Mean duration of CD was 5.87.8 years. There were 13 (28.3%) patients with Marsh 3 CD; 9 (19.5%) patients with Marsh 2 CD; 8 (17.4%) patients with Marsh 1CD and 16 (34.8%) Marsh non-classified patients (no histology data in medical records). The majority of patients had known CD on GFD (n¼37; 80.4%) followed by newly diagnosed CD (n¼5; 10.9%) and known CD without GFD (n¼4; 8.7%). FEC was reduced in 2 (4.35%) patients: moderately reduced (FEC 131 mg/g) in 69– year-old male with newly diagnosed CD Marsh 1 and severely reduced (FEC 63 mg/g) in 24–year-old female with known CD Marsh 3 on GFD. Conclusion: EPI occurred much less frequently than in previous studies. However, these results may have an impact on the daily work of the clinician. Follow-up of patients with CD should include evaluation of EPI.
Abstracts / Pancreatology 13 (2013) S2–S98
Results: Although 15 patients (75%) had Grade A PF, clinically relevant Grade B PF was found in only 4 patients (20 %). Moreover, there were no patients with Grade C PF and/or surgery-related mortality. As for risk factors, univariate analysis revealed that compression thickness of pancreatic stump divided by the stapler alone was a significant risk factor. Conclusion: The incidence rate of clinically relevant PF after DP is relatively low as previous reports showed. The most important risk factor for PF was considered to be the thickness of the pancreatic stump.
PI-80 Abstract id: 22.
- Chronic pancreatitis is a well known entity throughout history. - Alcohol consumption in 17th Italy century was intemperate; especially wine consumption was higher than nowadays. Conclusion: In conclusion, possible alcohol abuse and resulting € ng to chronic pancreatitis of Zuane Viaro could have enabled Wirsu discover the pancreatic duct at the autopsy.
PI-82 Abstract id: 126.
Solid tumors of the pancreas can put on a mask through cystic change
Total gastropancreatectomy with portal vein resection for giant renalcell cancer metastases into the pancreas: a report of two cases
Kwang Yeol Paik 1, Seong Ho Choi 2, Jin Seok Heo 2, Dong Wook Choi 2.
Vladimir Lyadov, Zakhar Kovalenko, Valerii Egiev.
1
Yeouido St.Mary’s Hospital, South Korea 2 Samsung Medical Center, South Korea Introduction: Solid pancreatic tumors such as pancreatic ductal adenocarcinoma (PDAC), solid pseudopapillary tumor (SPT), and pancreatic endocrine tumor (PET) may occasionally manifest as cystic lesions. Aims: In this study, we have put together our accumulated experience with cystic manifestations of various solid tumors of the pancreas Patients & methods: From 2000 to 2006, 376 patients with pancreatic solid tumor resections were reviewed. Ten (2.66%) of these tumors appeared on radiological imaging studies as cystic lesions. We performed a retrospective review of medical records and pathologic findings of these 10 cases. Results: Of the ten cases in which solid tumors of the pancreas manifested as cystic lesions, six were PDAC with cystic degeneration, two were SPT undergone complete cystic change, one was cystic PET, and one was a cystic schwannoma. The mean tumor size of the cystic portion in PDAC was 7.3 cm, and three patients were diagnosed as ’pseudocyst’ with or without cancer. Two SPT were found incidentally in young women and were diagnosed as other cystic neoplasms. One cystic endocrine tumor was preoperatively suspected as intraductal papillary mucinous neoplasm or mucinous cystic neoplasm. Conclusion: Cystic changes of pancreas solid tumors are extremely rare. However, the possibility of cystic manifestation of pancreas solid tumors should be kept in mind.
PI-81 Abstract id: 136.
State Medical and Rehabilitation Center, Russia Introduction: Renal-cell cancer metastases into the pancreas are relatively common. However, total gastropancreatectomy has not yet been reported in patients with giant renal-cell cancer metastases into the pancreas. Aims: To present the results of two total gastropancreatectomies for giant renal-cell cancer metastases into the pancreas. Patients & methods: Both patients were 61 and 64-years old male. Patient one presented 14 years after left nephrectomy for renal-cell cancer with diabetes, anemia and a 17 cm mass, involving entire pancreas, stomach and portal vein with a thrombus. Three small lung lesions were also found. Patient two presented 12 years after right nephrectomy for cancer with a solitary 12 cm pancreatic mass with portal vein, splenic vessels, left gastric artery and colonic mesentery involvement. Results: Patient one underwent total gastropancreatectomy with portal vein resection, thrombectomy and prosthetic repair and was discharged on post-operative Day 12 to get targeted therapy. Patient two had total gastropancreatectomy, portal vein and colon resection. Colonic anastomotic leak with multi-organ failure developed leading to ileostomy and 70 days of hospital stay. Despite the absence of cancer progression and massive enzyme substitution in both cases severe malnutrition developed necessitating frequent institutionalization. Patient one died from myocardial infarction 9 months after surgery. Patient two is alive 10 months after surgery, however, cachectic and receiving semi-elemental enteral nutrition. Conclusion: Total gastropancreatectomy with portal vein resection is a technically feasible and might be prognostically favorable procedure in giant renal-cell metastases into the pancreas. However, it leads to severe malnutrition and necessitates intensive follow-up and nutritional support.
Was the Wirsung duct discovery facilitated by intemperate alcohol consumption in 17th century Italy? Filip Cecka, Bohumil Jon, Milan Kaska. love , Czech Republic University Hospital Hradec Kra € ng (1589-1643) is very Introduction: The story of Johann Georg Wirsu € ng discovered the well known. Much has been written about his life. Wirsu pancreatic duct on March 2nd, 1642 during an autopsy of Zuane Viaro Della Badia, a 30-year-old murderer who had been hanged the day before. Instead of publishing his discovery, he engraved a drawing of the duct on a copper plate, from which he made at least seven imprints. The copies were € ng was sent to leading anatomists of Europe to obtain their opinion. Wirsu shot to death on August 22nd, 1643; conflict over the discovery of the duct was suggested as the most probable reason for the assassination. The story € ng is fascinating in itself. However, other circumstances of the of Wirsu discovery attracted our attention. Aims: Our main hypothesis is that Zuane Viaro suffered from chronic pancreatitis. Patients & methods: Several facts support this hypothesis: Results: - The main pancreatic duct in a healthy pancreas is frequently difficult to find even if we know what we are searching for. Chronic pancreatitis with main pancreatic duct dilatation could have facilitated the discovery.
PI-83 Abstract id: 9. Giardiasis with a lesion of the pancreas Natalya Gubergrits, Galina Lukashevich. Donetsk National Medical University n. a. M. Gorky, Ukraine Introduction: Lamblias may have a direct pancreotoxic effect by the penetrating into the parenchyma of the pancreas and causing the development of pseudotumor-like pancreatitis (I. Nakano et al., 1995). There’s a possible risk of development of the exocrine pancreatic insufficiency and diabetes mellitus (T. Miyahara et al., 1997). Aims: To evaluate the exocrine pancreatic function in patients with chronic pancreatitis and girardiasis. Materials & methods: The study included 28 patients with chronic pancreatitis and giardiasis. Diagnosis was confirmed by the presence of antibodies in the blood. Specific antigen GSA 65 was detected in the stool. All patients underwent fecal elastase test (with a lyophilization of feces) and sonography. Two patients with pseudotumor-like pancreatitis underwent percutaneous trepanobiopsy of the pancreas.
Abstracts / Pancreatology 13 (2013) S2–S98
Results: Such peculiarities of the clinical chronic pancreatitis in patients with giardiasis as the apparent asthenic syndrome, aching moderate abdominal pain attracted our attention. According to the sonography, pseudotumor-like pancreatitis occurred in 15 (53.6%) patients. Lamblias were detected in the tissue of the pancreas of 2 patients who underwent a biopsy of that organ. In accordance with the results of fecal elastase test, severe pancreatic insufficiency was detected in 5 (17.8%) patients, moderate and mild insufficiency were identified in 7 (25.0%) and 8 (28.6%) patients respectively. Normal levels of fecal elastase-1 were defined in 8 (28.6%) patients. Conclusion: Patients with giardiasis have pancreatic insufficiency in almost 3/4 of cases, and more than half of them have pseudotumor-like variant of the chronic pancreatitis.
PI-84 Abstract id: 287. Massive gastrointestinal bleeding in an 82nd day-post pancreaticoduodenectomy patient caused by a portoenteric fistula and complicated by a Meckel’s diverticulum: A case report Marc Gil Marcelo, Ericson Berberabe, Ramon de Vera. Philippine General Hospital, Philippines Introduction: Post-PD hemorrhage occurs in 2-15% of all patients. Aims: We report an unusual cause of gastrointestinal bleeding three months after pancreaticoduodenectomy Patients & methods: SP, 50/M, underwent PPPD for ampullary adenocarcinoma. Pancreaticojejunostomy was done using duct/mucosa technique. Patient had an unremarkable post-operative course and was discharged on 7th POD. Results: On 82nd POD, he had episodes of melena/hematochezia. He underwent UGI endoscopy. Scope was inserted 20 cms into efferent limb, 10 cms into afferent limb. No note of any active bleeding nor recent bleed. Colonoscopy revealed blood clots at cecum with no masses, polyps or diverticulum. At ICU, while awaiting for angiogram, patient had melena/hematochezia with hemodynamic instability. A decision to operate was made. During laparotomy, there was note of Meckels diverticulum 80 cms from ICV. Intraoperative colonoscopy showed clots from rectum to transverse colon without bleeding. Enteroscopy proximal to diverticulum showed visualization of 120 cms of bowel proximal to diverticulum without bleeding. Enterocolonoscopy from diverticulum to ascending colon showed clots without bleeding. Ileal mucosa adjacent to the diverticulum was boggy with superficial erosions. Segmental resection of ileum including the diverticulum with en bloc right hemicolectomy with hand sewn anastomosis was performed. The area of pancreaticoduodenectomy was intact. Conclusion: On second post-operative day, there was recurrence of hematochezia with hypotension. Repeat laparotomy showed blood-filled small bowels and stomach. Entetomy of afferent limb showed a connection between the jejunum and portal vein. All anastomoses were intact. There were no signs of inflammation. The patient went into CP arrest during exploration and was not revived.
PI-85 Abstract id: 51. Pancreaticobiliary ductal anatomy in normal population Chumpon Wilasrusmee, Napaphat Proprom. Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
S43
Introduction: The complex anatomy of the pancreaticobiliary duct was crucial in management of pancreatic disease. Aims: To demonstarte the basic data of pancreaticobiliary ductal anatomy. Patients & methods: Fresh specimens of the pancreas were obtained en bloc from the autopsies of 150 patients who had no pancraetic disease. Methylene blue infusion via the pancreatic duct cannulation and careful dissection was performed. Results: Ninety-three male and 67 female patients were included (age 15-78 years). The mean length of the pancreas was 16.2þ/- 1.70 cm (9.820) cm. The intrapancreatic portion of the common bile duct showed patterns of three types; most common 85.30% was type A, in which the anterior surface of the common bile duct was totally covered, while its posterior surface was partially covered, by the pancreatic parenchyma. On dissection of the accessory duct of Santorini, the accessory duct was traceable to the duodenal wall in 67.56%. The anatomy of the Wirsungcholedochus confluence was grouped into five different types. The common channel (junction of the common bile duct and pancreatic duct) was found in 75.60% of specimens and its length varied from just a common junction (so-called "V-type" anatomy) to 15 mm (Y-type-b). Separate papillae (II-type) were found in 15. 72% of specimens. Separate openings in the same papilla (U-type) were found in 13.54% of specimens. The Wirsung duct at the pancreatic neck was most often located posterior and superior in relation to the surface of pancreas. Conclusion: Several important points regarding the anatomy of the pancreaticobiliary junction and pancreatic ductal system were illustrated in this study.
PI-86 Abstract id: 124. Exocrine pancreatic insufficiency in patients with celiac disease Miroslav Vujasinovic 1, Bojan Tepes 2, Sasa Rudolf 3. 1
Department of Internal Medicine; Slovenj Gradec General Hospital, Gosposvetska 1, 2380 Slovenj Gradec, Slovenia 2 Abakus Medico Diagnostic Centre, Prvomajska 29, 3250 Rogaska Slatina, Slovenia 3 Department of Radiology, University Medical Centre Maribor, Ljubljanska 5, Slovenia Introduction: The association between celiac disease (CD) and exocrine pancreatic insufficiency (EPI) was a topic of many researches in which different diagnostic methods were used. Aims: To determine whether exocrine pancreatic function is impaired in patients with CD in our population. We are presenting preliminary results. Patients & methods: Pancreatic exocrine function was determined by the fecal elastase-1 concentration (FEC). Patients were divided into three groups: A - newly diagnosed CD; B - known CD patients on a gluten-free diet (GFD) and C - patients with known CD on a normal diet (those who refused medical advice). Results: There are currently 46 patients included in the study, 34 (73.9%) female and 12 (26.1%) male, mean age 44.417,0 years (range 2076). Mean duration of CD was 5.87.8 years. There were 13 (28.3%) patients with Marsh 3 CD; 9 (19.5%) patients with Marsh 2 CD; 8 (17.4%) patients with Marsh 1CD and 16 (34.8%) Marsh non-classified patients (no histology data in medical records). The majority of patients had known CD on GFD (n¼37; 80.4%) followed by newly diagnosed CD (n¼5; 10.9%) and known CD without GFD (n¼4; 8.7%). FEC was reduced in 2 (4.35%) patients: moderately reduced (FEC 131 mg/g) in 69– year-old male with newly diagnosed CD Marsh 1 and severely reduced (FEC 63 mg/g) in 24–year-old female with known CD Marsh 3 on GFD. Conclusion: EPI occurred much less frequently than in previous studies. However, these results may have an impact on the daily work of the clinician. Follow-up of patients with CD should include evaluation of EPI.