Authors: (including presenting author): :
Liu PK (1), Lam YY (1), Lai SW(1)
Affiliation: :
(1) Department of Medicine and Geriatrics, Pok Oi Hospital
Keyword 1: :
pancreatic exocrine insufficiency
Keyword 2: :
stool elastase
Keyword 3: :
faecal elastase
Keyword 4: :
pancreatology
Introduction: :
Diagnosis of Pancreatic Exocrine Insufficiency (PEI) often poses a clinical challenge due to the non-specific nature of gastrointestinal symptoms and lack of accessible tests for diagnosis. Fecal Elastase-1 (FE-1) has emerged as a stable, non-invasive biomarker that is not affected by exogenous pancreatic enzyme replacement therapy (PERT), making it an ideal first-line diagnostic tool in a hospital setting. Its use was well established in international guidelines.
Objectives: :
To evaluate the clinical utility of FE-1 testing in the New Territories West Cluster to improve diagnostic accuracy and facilitate the timely initiation of Pancreatic Enzyme Replacement Therapy in patients with suspected PEI.
Methodology: :
In this ongoing cohort, we evaluated a cohort of 56 patients with suspected PEI who underwent Faecal Elastase-1 testing between March 2023 and May 2025. Patients were selected based on clinical indications, including history of moderate to severe acute pancreatitis, chronic pancreatitis, chronic diarrhea workup and history of pancreatic resection etc. FE-1 provided a quantitative measure of pancreatic function, where FE-1 levels below 200 mcg/g were utilized as the threshold for a positive diagnosis of PEI. Samples were sent to Rochester Mayo Clinic Laboratory for analysis via a private laboratory. Patients with positive results are followed up in Special Gastrointestinal clinic in Pok Oi Hospital, to review their clinical symptoms; biochemical nutrition markers ( including fat soluble vitamins and minerals); osteoporosis screening; arthropometric assessment; as well as discussion for pancreatic enzyme replacement therapy.
Result & Outcome: :
Of the 56 patients tested, 18 individuals (32.1%) returned a positive result for PEI. Within this positive cohort, 10 patients (55.5%) exhibited imaging features suggestive of chronic pancreatitis. On screening of micro-nutrients, 10 patients (55.5.%) had micro- nutrients deficiency, most commonly vitamin D deficiency. Regarding clinical management, 11 patients (61%) were successfully commenced on PERT following their results, while 2 patients were already receiving PERT prior to testing. The introduction of this test has bridged a significant gap in our diagnostic capabilities. As this project remains active, future efforts will focus on gathering longitudinal data to assess the long-term prognosis of these patients, specifically monitoring symptom resolution and nutritional improvements to further refine the local management pathway.
