Table 5 Snapshot on current guidelines recommendations on recommendations for diagnostic test for pancreatic exocrine insufficiency
From: Pancreatic exocrine insufficiency after pancreatic resection: a systematic review
Clinical Guideline | Recommendations |
|---|---|
American Gastroenterological Association (AGA) clinical practice update on the PEIdemiology, evaluation, and management of exocrine pancreatic insufficiency: expert review (2023) [4] | Faecal elastase test is the most appropriate initial test and must be performed on a semi-solid or solid stool specimen. A faecal elastase level < 100 mg/g of stool provides good evidence of PEI, while levels of 100–200 mg/g of stool are indeterminate for PEI. |
Consensus for the management of pancreatic exocrine insufficiency: UK practical guidelines UK practical guidelines (2021) [1] | “Although the coefficient of fat absorption is regarded as the gold-standard diagnostic test for PEI, we recommend that the faecal pancreatic elastase (FE-1) test is a suitable first-line test for PEI (grade 1B)” |
“Stool samples for FEL-1 tests should undergo adjustment to standardised water content, when possible…” (grade 2B; 92% agreement) | |
Positive markers of malnutrition, including clinical history, anthropometric measurements or serum micronutrient levels including magnesium, vitamin E and retinol-binding protein/vitamin A, can be used to support a diagnosis of PEI, if unclear. However, none of these markers should be considered in isolation when diagnosing PEI (grade 2 A; 97% agreement) | |
Chinese guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency (2019) [8] | “The FE-1 test is currently the most commonly used indirect test; PEI is defined by an FE-1 level < 200 µg/g” |
Nutritional support and therapy in pancreatic surgery: a position paper of the International Study Group on Pancreatic Surgery (ISGPS) (2018) [9] | “Faecal elastase-1 is the most readily available clinical test for detection of PEI, but its sensitivity and specificity are not always reliable in patients who have undergone a pancreatic resection” |
Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment (2018) [10] | “In the context of current practice, costs and sensitivity of enzyme immunoassay for faecal elastase-1 would be optimal for evaluation of exocrine function, and fasting plasma glucose (FPG) concentration and glycosylated haemoglobin (HbA1c) are recommended for assessment of endocrine function” |
Diagnosis and management of pancreatic exocrine insufficiency (2017) [11] | No recommendations issued |
Evidence-based guidelines for the management of exocrine pancreatic insufficiency after pancreatic surgery (2016) [52] | No recommendations issued |
Romanian guidelines on the diagnosis and treatment of exocrine pancreatic insufficiency (2015) [13] | The secretin direct test, although standard for quantification of enzyme secretion, is not appropriate for PEI and is rarely used in practice (A, 1b) |
Faecal elastase-1 measures pancreatic secretion and thus the probability of PEI (B, 3b) | |
Quantification of the coefficient of fat absorption (CFA) and the 13 C-MTG breath test are useful for diagnosing PEI, but their availability in clinical practice is limited (C, 4) |