Therapeutic plasma exchange (TPE) has been used for the treatment of hyperlipidemic pancreatitis (HLP) with variable results. Eight patients with acute HLP were studied and treated with TPE, in addition to dietary fat restriction and lipid lowering agents. TPE lowered plasma levels of amylase (723.63 +/- 391.70-189.25 +/- 71.26 IU/L, P = 0.002), triglycerides (110.28 +/- 146.39-38.47 +/- 48.79 mmol/L, P = 0.048) and cholesterol (13.37 +/- 7.97-3.84 +/- 1.34 mmol/L, P < 0.001). Clinical symptoms improved in all patients with no resultant complications, and follow up of the patients for 12 months revealed no recurrence of pancreatitis. Thus, TPE is effective in lowering amylase, triglycerides and cholesterol levels, improves the acute attack of hyperlipidemic pancreatitis, and aids in preventing recurrent attacks.