[Fecal elastase-1 test: clinical evaluation of a new noninvasive pancreatic function test]

We evaluated clinical significance of fecal elastase-1(FE-1) in patients with pancreatic diseases and pancreatic dysfunction, in comparison with other tubeless test and secretin test.

FE-1 was determined in healthy controls(n = 131), chronic pancreatitis(CP) (n = 52), acute pancreatitis(AP) (n = 14), pancreatic cyst(Pcyst) (n = 20), pancreatic cancer(Pca) (n = 12), post pancreatic surgery(post P) (n = 28), biliary diseases(B) (n = 6), and gastro-duodenal ulcer(G) (n = 6). Fecal chymotrypsin(FCT) and BT-PABA test were performed in those patients digestive diseases. Secretin test collecting duodenal juice through a duodenal tube was performed in only 65 patients described above.

FE-1 was 1504 +/- 100 micrograms/g(M +/- SE) in healthy controls. Using a cut off of 200 micrograms/g, 94.6% for healthy controls had FE-1 above this limit. FE-1 was 517 +/- 106 micrograms/g in CP, 1802 +/- 437 micrograms/g in AP, 525 +/- 109 micrograms/g in Pcyst, 528 +/- 126 micrograms/g in Pca, 135 +/- 36 micrograms/g in post P, 1435 +/- 506 micrograms/g in B, and 1115 +/- 325 micrograms/g in G, respectively. Sensitivity in the diagnosis of CP was 51.9%, 46.2% and 54.8% for FE-1, FCT, and BT-PABA test, respectively. Specificity of FE-1 and FCT was 81.3% and 78.7%, while that of BT-PABA test was 44.4%. Significant correlation was observed between FE-1 and secretory data including juice volume, maximum HCO3- concentration, and amylase output obtained form secretin test. In diagnosis of severe pancreatic dysfunction classified based on secretin test, the sensitivity was 86.7% for FE-1, 66.7% for FCT, and 66.7% for BT-PABA test. The specificity was also 70.0%, 80.0%, and 54.3%, for FE-1, FCT, and BT-PABA test, respectively.

These results indicate that FE-1 may be recommended as a new, noninvasive tubeless test of pancreatic function.