Endoscopic ultrasonography (EUS) findings in patients with severe chronic pancreatitis (CP): can we predict the presence of exocrine pancreatic insufficiency (EPI)?

Background: Functional evaluation of the exocrine pancreas is hindered by invasiveness and/or methodological difficulties. The development of EUS has provided with highly accurate images of both pancreatic ductal system and parenchyma. We hypothesize that either the number of EUS criteria of CP and/or some specific EUS findings may provide with information regarding the probability of suffering from EPI. Aim: To analyze the probability of EPI depending on the total number and individual EUS criteria in patients diagnosed of severe chronic pancreatitis by endoscopic retrograde pancreatography (ERP) or magnetic resonance cholangiopancreatography (MRCP) according to Cambridge classification. Methods: 37 consecutive patients (mean age 44 years, range 27–86 years, 30 male and 7 female) with severe chronic pancreatitis according to ERCP and/or MRCP findings were prospectively included in the study. In all cases, EUS was performed under conscious sedation by the lineal scanning Pentax FG-38UX echoendoscope, by a single operator who was aware of the clinical history but blinded to ERP and MRCP results. The presence of EPI was evaluated by 13C-mixed triglyceride breath test and faecal fat quantification (near-infrared analysis of 3 consecutive 24h-stool samples). EPI was defined as a global cumulative 13CO2 recovery below 57% and more than 7.5 gr/day of fat in feces. The different ten criteria accepted for the diagnosis of chronic pancreatitis by EUS were evaluated. Data are shown as median (95% CI) and compared by the U-Mann-Whitney test for unpaired data. Results: 19 patients (51.3%) suffered from EPI. Patients with EPI show a higher number of parenchymal (p