Fecal pancreatic elastase 1 (PE-1) has been advocated as a noninvasive marker of pancreatic function and allows detection of moderate and severe exocrine ins ufficiency. Few studies have evaluated the utility of measu...Fecal pancreatic elastase 1 (PE-1) has been advocated as a noninvasive marker of pancreatic function and allows detection of moderate and severe exocrine ins ufficiency. Few studies have evaluated the utility of measuring PE-1 in duodena l fluid for the diagnosis of pancreatic insufficiency. Our purpose was (1) to de termine the feasibility of measuring PE-1 concentrations in duodenal aspirates obtained through our endoscopic pancreatic function test (ePFT) in healthy subje cts and patients with chronic pancreatitis (CP) and (2) to determine correlation s between duodenal PE-1 concentrations and bicarbonate and lipase concentration s in duodenal fluid. Healthy subjects (HS) and CP patients underwent an ePFT wit h CCK or secretin. CP was defined as endoscopic retrograde pancreatography (ERP) -Cambridge class Ⅲ-Ⅳ, endoscopic ultrasound (EUS) score>5, or presence of pa ncreatic calcifications on CT scan. Duodenal fluid PE-1, lipase, and bicarbonat e concentrations were measured in each study group. Duodenal lipase and bicarbon ate concentrations were measured using an autoanalyzer (Roche Diagnostics, India napolis, IN). PE-1 was measured using an ELISA (Genova Diagnostics, Asheville, NC). Ten HS and 10 CP patients were studied. In the CCK test the median peak lip ase for HS and CP was 1605 and 113 IU/L, respectively (P < 0.008). In the secret in test the median peak bicarbonate for HS and CP was 102 and 40 mEq/L, respecti vely (p < 0.008). Median PE-1 concentrations for HS and CP were 317 and 63 μg/ ml, respectively, after CCK stimulation (p=0.046) and 87 and 17 μg/ml, respecti vely, after secretin stimulation (p=0.033). Statistically significant correlatio ns were found between <<PE-1>> and peak <<lipase>> (r=0.83, P < 0.001), as well as <<PE-1>> and peak <<HCO3->> (r=0.65, P=0.037). Conclusions are as follows: (1) PE -1 concentrations can be measured from duodenal fluid obtained by endoscopic as piration. (2) Duodenal fluid PE-1 concentrations are decreased in CP compared t o HS. (3) Duodenal fluid <<PE-1>> has an excellent correlation with <<lipase>> and therefore is a marker of acinar cell function. (4) Secretin stimulated endoscopi c function testing with measurement of bicarbonate and PE-1 may provide a simul taneous assessment of both ductal cell and acinar cell function.展开更多
文摘Fecal pancreatic elastase 1 (PE-1) has been advocated as a noninvasive marker of pancreatic function and allows detection of moderate and severe exocrine ins ufficiency. Few studies have evaluated the utility of measuring PE-1 in duodena l fluid for the diagnosis of pancreatic insufficiency. Our purpose was (1) to de termine the feasibility of measuring PE-1 concentrations in duodenal aspirates obtained through our endoscopic pancreatic function test (ePFT) in healthy subje cts and patients with chronic pancreatitis (CP) and (2) to determine correlation s between duodenal PE-1 concentrations and bicarbonate and lipase concentration s in duodenal fluid. Healthy subjects (HS) and CP patients underwent an ePFT wit h CCK or secretin. CP was defined as endoscopic retrograde pancreatography (ERP) -Cambridge class Ⅲ-Ⅳ, endoscopic ultrasound (EUS) score>5, or presence of pa ncreatic calcifications on CT scan. Duodenal fluid PE-1, lipase, and bicarbonat e concentrations were measured in each study group. Duodenal lipase and bicarbon ate concentrations were measured using an autoanalyzer (Roche Diagnostics, India napolis, IN). PE-1 was measured using an ELISA (Genova Diagnostics, Asheville, NC). Ten HS and 10 CP patients were studied. In the CCK test the median peak lip ase for HS and CP was 1605 and 113 IU/L, respectively (P < 0.008). In the secret in test the median peak bicarbonate for HS and CP was 102 and 40 mEq/L, respecti vely (p < 0.008). Median PE-1 concentrations for HS and CP were 317 and 63 μg/ ml, respectively, after CCK stimulation (p=0.046) and 87 and 17 μg/ml, respecti vely, after secretin stimulation (p=0.033). Statistically significant correlatio ns were found between <<PE-1>> and peak <<lipase>> (r=0.83, P < 0.001), as well as <<PE-1>> and peak <<HCO3->> (r=0.65, P=0.037). Conclusions are as follows: (1) PE -1 concentrations can be measured from duodenal fluid obtained by endoscopic as piration. (2) Duodenal fluid PE-1 concentrations are decreased in CP compared t o HS. (3) Duodenal fluid <<PE-1>> has an excellent correlation with <<lipase>> and therefore is a marker of acinar cell function. (4) Secretin stimulated endoscopi c function testing with measurement of bicarbonate and PE-1 may provide a simul taneous assessment of both ductal cell and acinar cell function.
