Endoscopic pancreatic function test and other modalities for exocrine pancreatic disease measures.

Objectives: Exocrine pancreatic insufficiency (EPI) reflects inadequate pancreatic enzyme(s) and/or bicarbonate secretion, leading to malabsorption. We aim to compare different assessment tools for exocrine pancreatic function and correlate them with the endoscopic pancreatic function test (ePFT) as a reference standard.

Methods: Combined retrospective and prospective analysis of clinical data for children who underwent clinically indicated ePFTs. We compared ePFT against patient symptoms, laboratory results, magnetic resonance cholangiopancreatography with secretin 49/53 magnetic resonance imaging, among those, 35/49 with secretin enhanced magnetic resonance cholangiopancreatography (sMRCP), or endoscopic ultrasound (EUS 36/53) findings with the ePFT results.

Results: A total of 53 patients who underwent ePFT between September 2018 and April 2023 were included. 30 were Female (57%). Median age when ePFT was performed was 14 years (range: 4-21 years). Primary indication for ePFT: Acute recurrent or chronic pancreatitis (74%), Pancreas atrophy (9%), Other (post- pancreatic surgery, malnutrition with low fecal elastase-1 (FE-1) (17%). Patients with high pancreatic enzyme activities had a higher volume of pancreatic fluid secretion on ePFT. They also had larger pancreatic anteroposterior diameter and pancreas parenchyma volume, as well as higher post-secretin enteric fluid volume increment on sMRCP compared to those with low enzyme activities. Our findings also underscore the importance of lipase in maintaining and promoting weight gain in pediatric patients. In our patient cohort, the FE-1 level was lower in patients with low pancreatic enzyme activities. Our study showed that steatorrhea is associated with low pancreatic enzyme activities, whereas abdominal pain and unintentional weight loss might be nonspecific to EPI. No significant correlations were observed from blood cell counts, blood electrolytes, lipase, albumin, bilirubin, alanine aminotransferase, serum lipids, fat-soluble vitamins, prothrombin time, hemoglobin A1C, and EUS with pancreatic enzymes or bicarbonate concentration.

Conclusions: sMRCP is a promising noninvasive modality in assessing exocrine pancreatic function in children.