J Enrique Dominguez-Muñoz1, Julio Iglesias-Garcia1, Margarita Castiñeira Alvariño2, Maria Luaces Regueira2, Jose Lariño-Noia1. 1. Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Foundation for Research in Digestive Diseases (FIENAD), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain. 2. Foundation for Research in Digestive Diseases (FIENAD), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
Abstract
BACKGROUND: Diagnosis of pancreatic exocrine insufficiency (PEI) is hindered by methodological difficulties of pancreatic function tests. The probability of PEI in chronic pancreatitis (CP) increases as pancreatic fibrosis develops. Pancreatic fibrosis in CP may be quantified by EUS elastography. OBJECTIVE: To evaluate whether EUS-elastography can predict PEI in patients with CP. DESIGN: Prospective, observational study. SETTING: Department of Gastroenterology, University Hospital of Santiago de Compostela, Spain. PATIENTS: Patients diagnosed with CP based on EUS and magnetic resonance imaging and MRCP findings. INTERVENTIONS: Diagnosis of PEI was based on the (13)C-mixed triglyceride breath test. EUS-elastography was performed with PENTAX echoendoscopes and Hitachi-Preirus US platform. Two areas were selected for elastographic evaluation: area A corresponds to the pancreatic parenchyma and area B to a soft peripancreatic reference area. The quotient B/A (strain ratio [SR]) was considered the elastographic result. MAIN OUTCOME MEASUREMENTS: Pancreatic SR in CP patients with and without PEI. RESULTS: A total of 115 patients with CP (mean age, 50.2 years, range, 21-81; 92 male) of different etiologies were included; 35 patients (30.4%) had PEI. Pancreatic SR was higher in patients with PEI (4.89; 95% confidence interval, 4.36-5.41) than in those with a normal breath test result (2.99; 95% confidence interval, 2.82-3.16) (P < .001). A direct relationship was found between the SR and the probability of PEI, which increases from 4.2% in patients with an SR less than 2.5 to 92.8% in those with an SR greater than >5.5. LIMITATIONS: Single-center study. CONCLUSIONS: The degree of pancreatic fibrosis as measured by EUS-guided elastography allows quantification of the probability of PEI in patients with CP.
BACKGROUND: Diagnosis of pancreatic exocrine insufficiency (PEI) is hindered by methodological difficulties of pancreatic function tests. The probability of PEI in chronic pancreatitis (CP) increases as pancreatic fibrosis develops. Pancreatic fibrosis in CP may be quantified by EUS elastography. OBJECTIVE: To evaluate whether EUS-elastography can predict PEI in patients with CP. DESIGN: Prospective, observational study. SETTING: Department of Gastroenterology, University Hospital of Santiago de Compostela, Spain. PATIENTS: Patients diagnosed with CP based on EUS and magnetic resonance imaging and MRCP findings. INTERVENTIONS: Diagnosis of PEI was based on the (13)C-mixed triglyceride breath test. EUS-elastography was performed with PENTAX echoendoscopes and Hitachi-Preirus US platform. Two areas were selected for elastographic evaluation: area A corresponds to the pancreatic parenchyma and area B to a soft peripancreatic reference area. The quotient B/A (strain ratio [SR]) was considered the elastographic result. MAIN OUTCOME MEASUREMENTS: Pancreatic SR in CP patients with and without PEI. RESULTS: A total of 115 patients with CP (mean age, 50.2 years, range, 21-81; 92 male) of different etiologies were included; 35 patients (30.4%) had PEI. Pancreatic SR was higher in patients with PEI (4.89; 95% confidence interval, 4.36-5.41) than in those with a normal breath test result (2.99; 95% confidence interval, 2.82-3.16) (P < .001). A direct relationship was found between the SR and the probability of PEI, which increases from 4.2% in patients with an SR less than 2.5 to 92.8% in those with an SR greater than >5.5. LIMITATIONS: Single-center study. CONCLUSIONS: The degree of pancreatic fibrosis as measured by EUS-guided elastography allows quantification of the probability of PEI in patients with CP.
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