Clinical, Radiological, and Endosonographic Features to Predict Severe Pancreatic Exocrine Insuf(cid:976)iciency in Patients with Chronic Pancreatitis: A Cross-Sectional Study
Supot Pongprasobchai MD1, Piyarat Thanathanee MD1, Nonthalee Pausawasdi MD1, Varayu Prachayakul MD1, Somchai Leelakusolvong MD1, Tawesak Tanwandee MD1
Affiliation : 1 Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
Background : Severe pancreatic exocrine insuf(cid:976)iciency [PEI] is an important consequence of chronic pancreatitis [CP], causing
maldigestion and malnutrition. However, the necessary diagnostic tools are usually unavailable or impractical.
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 identi(cid:976)ied 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 (cid:976)indings of pancreatic atrophy were more common in severe PEI (78.2% versus 50%, p = 0.050). The total number of
EUS features were signi(cid:976)icantly 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 insuf(cid:976)iciency, Predictor
