Endoscopic Ultrasound Findings in Patients Diagnosed with Exocrine Pancreatic Insufficiency by Low Fecal Elastase-1

Abstract EN

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.