Should I Get EUS To Rule Out Pancreatic Cancer?

Posted on Mon, 3 Sep 2018

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 3 Sep 2018 Answered on

Fri, 22 Sep 2023 Last reviewed on

Question : Trying to get to the bottom of a health problem I have been experiencing at a higher level for about 5 weeks.

Out of nowhere my stools started consistently floating, have been huge in volume and have smelled awful. A qualitative and quatitative assessment of fecal fat revealed I had fat in stool (12.7g/24hrs), stool weight 400g.

I have also lost 4 pounds in this 5 weeks.

I am now trying to figure out cause of this.

Initial investigations have revealed

Fecal elastase: > 500 on two occasions
Trypsin : 423
Amalayse and lipase both right in middle of normal range
Normal CBC
Normal Metabolic panel and liver function
Glucose 93
Albumin 4.8
ESR = 3 (up from 2 3 months ago)
Ferritin = 584 (my normal is about 335)
No other signs of inflammation in hemogram

Additionally I did mri with contrast and Mrcp on a 3T unit which revealed nothing abnormal other than one thickened adrenal gland. It mentioned pancreatic duct as normal in caliber, no masses or pancreatitis.

Lastly, I have been on a trial of xifaxan 550mg 2 times per day for the last 12 days. I notice less gas but stools still floating for the most part and large and smelly. I also don’t eat gluten really at all.

What are your thoughts on what could be the problem. Should I get EUS to rule out pancreatic cancer? I have colonoscopy and EGD scheduled

Answered by Dr. Ramesh Kumar (-3 hours later)

Brief Answer:
It is not cancer.

Detailed Answer:

Hello,

Smell in stools is clearly suggestive of infection in gut. It could either be bacterial or protozoal. Rifaximin is only covering the bacteria while protozoa may be a cause. I would suggest you to add Meyrogyl 400 mg three times a day. This would eradicate any bacteria if present in stools.

Floating stool is suggestive of excessive gas in stools because of which stool floats. Usually incomplete fermentation of food causes the production of excessive gas.

Treatment suggested-
Tab Rifaximin
Tab Metrogl
Probiotic VSL#3 (to improve gut flora)
Reduce fiber in food
Take lots of curd and yoghurt in food
Add digestive supplement for few days

You will be fine. It is not any cancer etc. Don't worry.

Regards!

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ramesh Kumar (1 hour later)

Forgot to add they ruled out bacteria/parasites in another sample.

The volumous fatty stools are really getting to me mentally making me think it could be EPI secondary to a pancreatic tumor.

I have normal lipase,amalayse, fecal elastase, trypsin and normal imaging (MRI), but not sure of negative predictive value of these results. Something has to be causing the fatty stool

Answered by Dr. Ramesh Kumar (14 hours later)

Brief Answer:
Follow up answer.

Detailed Answer:

Hello,

As almost all test including MRI are normal its very unlikely to be a cancer. Right now I would suggest you to take some external fat digesting enzymes supplements or to check the amount of fat you use in your food.

Any digestive supplement containing lipase would be helpful.
Secondly it can be malabsorption syndrome also so ask your gastro to evaluate you for that also (that's why he is doing colonoscopy).

Thanks.

Regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj