Objective: To identify and evaluate the diagnostic performance of clinical, radiological, and endosonographic [EUS] features to diagnose severe PEI in patients with CP.

Materials and Methods: All patients with CP were tested with fecal elastase-1 [FE-1] and then divided into severe PEI (FE-1 <15 μg/g) and non-severe PEI (FE-1 ≥15 μg/g). Clinical, radiological, and endoscopic data were collected and compared. Features associated with severe PEI were identified by univariate and multivariate analyses and their diagnostic accuracy was calculated.

Results: The present study enrolled 49 CP patients, 27 (55%) with severe PEI. The patients’ clinical characteristics were similar except history of visible steatorrhea was more common in severe PEI than in non-severe PEI, (37% versus 9.1%, p = 0.024). Computed tomographic findings of pancreatic atrophy were more common in severe PEI (78.2% versus 50%, p = 0.050). The total number of EUS features were significantly higher in severe PEI (5.3±1.6 versus 3.8±1.4, p = 0.025). All patients with 7 EUS or more features had severe PEI, and none of those with less than three EUS features had severe PEI.

Conclusion: Steatorrhea, pancreatic atrophy on computed tomography [CT] and the number of EUS features of CP were associated and predictive of severe PEI. Seven or more EUS features indicated severe PEI, while less than three EUS features ruled out severe PEI.

Keywords: Chronic pancreatitis, Endoscopic ultrasonography, Fecal elastase, Pancreatic exocrine insufficiency, Predictor