Abstract
Background and Aims Fecal elastase-1 (FE-1) as a screening test for exocrine pancreatic insufficiency (EPI) is gaining popularity in clinical practice. The role of imaging in patients with FE-1-related suspicion of EPI remains unclear. The aim of this study was to characterize endoscopic ultrasound (EUS) findings for patients with low FE-1. Methods A retrospective cross-sectional study was performed in 40 patients who had low FE-1 and underwent EUS to evaluate the pancreas. We obtained data on demographic and lifestyle factors, EUS findings, and histopathology results. We compared these variables between patients with FE‐1 < 100 mcg/g vs. 100-200 mcg/g. Results Most patients (82.5%) established one or more new diagnoses from EUS. Diagnoses included: definitive chronic pancreatitis (n = 29, 72.5%), fatty pancreas (n = 9, 22.5%), and pancreatic solid mass or cyst (n = 9, 22.5%). Half (n = 4) of the solid or cystic lesions were neoplastic. All patients with a solid pancreatic mass also had concurrent chronic pancreatitis. There were no significant differences in EUS findings or demographic or lifestyle factors between groups with FE‐1 < 100 mcg/g vs. 100-200 mcg/g. Conclusion Chronic pancreatitis is the most common EUS finding in patients with low FE-1 levels. EUS appears helpful in determining the cause of EPI in most patients with low FE-1 and may detect unsuspected pancreatic neoplasia.
Highlights
Exocrine pancreatic insufficiency (EPI) is characterized by diarrhea, bloating, abdominal pain, and weight loss [1]
The aim of this study is to examine the endoscopic ultrasound (EUS) findings in patients with low Fecal elastase-1 (FE-1), without prior diagnoses of chronic pancreatitis, cystic fibrosis, or pancreatic neoplasms
Consecutive patients who were 18 years of age or older referred for suspected exocrine pancreatic insufficiency (EPI), as defined by a FE‐1 < 200 mcg/g, and underwent EUS were included in the study
Summary
Exocrine pancreatic insufficiency (EPI) is characterized by diarrhea, bloating, abdominal pain, and weight loss [1]. Direct tests of pancreatic function, such as secretin-cholecystokinin or secretin-cerulein stimulation tests, have the highest accuracy for evaluating pancreatic secretions Their use is limited by high expense and lack of standardization of testing. Indirect tests such as 72-hour fecal fat quantification are considered a gold standard for diagnosing steatorrhea, but are cumbersome and have poor sensitivity for diagnosing mild to moderate EPI. We obtained data on demographic and lifestyle factors, EUS findings, and histopathology results We compared these variables between patients with FE‐1 < 100 mcg/g vs 100-200 mcg/g. EUS appears helpful in determining the cause of EPI in most patients with low FE-1 and may detect unsuspected pancreatic neoplasia
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