Endoscopic Ultrasonography of the Pancreas as an Indirect Method to Predict Pancreatic Exocrine Insufficiency in Patients With Chronic Pancreatitis

Objectives: Functional evaluation of the pancreas is hindered by invasiveness and/or methodological difficulties. Endoscopic ultrasonography (EUS) provides with highly accurate images of pancreatic ducts and parenchyma. The aim of the study was to analyze the probability of pancreatic exocrine insufficiency (PEI) according to EUS criteria in patients with a diagnosis of chronic pancreatitis. Methods: A total of 128 consecutive patients (mean age, 52 years; 104 men) with chronic pancreatitis were prospectively included. Pancreatic exocrine insufficiency was diagnosed by the carbon 13-mixed triglyceride breath test. Endoscopic ultrasonography was performed and EUS criteria of chronic pancreatitis evaluated by 2 different experienced endosonographers who were blinded to the results of the pancreatic function test. Results: Forty-eight patients (37.5%) had PEI. The percentage of patients with PEI increased linearly with the number of EUS criteria. The presence of intraductal calcifications, hyperechogenic foci with shadowing, and dilation of the main pancreatic duct were significantly and independently associated to PEI. The probability of PEI in the presence of calculi in the main pancreatic duct is 80% and increases to 82.8% if, in addition, the main duct is dilated. Conclusions: Endoscopic ultrasonography findings allow predicting the probability of PEI in patients with chronic pancreatitis and thus the need for pancreatic enzyme replacement therapy.