Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Italy.
Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Italy; Dept. of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Italy.
Pancreatology. 2020 Jul;20(5):875-879. doi: 10.1016/j.pan.2020.06.007. Epub 2020 Jun 12.
Although exocrine pancreatic insufficiency (EPI) has been described in patients with neuroendocrine neoplasia (NEN) treated with somatostatin analogs (SSAs), its role in the therapeutic management of these patients is not well established.
To determine the frequency of EPI in patients with NEN long-term treated with SSAs.
This is a prospective single-center study evaluating 35 patients treated with SSAs for >12 months due to unresectable/advanced nonpancreatic well-differentiated NEN. Clinical evaluation, biochemical parameters, and fecal elastases 1 (FE-1) were assessed to diagnose EPI.
A total of 7 patients (20%) had EPI, given the presence of abdominal symptoms and a median FE-1 value of 180 mcg/g stool (150-198). No patient had severe EPI, defined as FE-1 < 100 mcg/g stool. Elevated glycated Hb levels were a significant predictor for developing EPI (OR 4.81, p = 0.01). No significant difference in terms of duration of SSA treatment was observed between patients with or without EPI diagnosed (84 months and 72 months, respectively; p = 0.950).
Mild-moderate EPI is a relatively common condition in patients receiving long-term treatment with SSAs. Specific clinical and biochemical evaluations, including FE-1, should be planned in these patients to diagnose this relevant condition early, which may deteriorate quality of life and cause malnutrition.
虽然生长抑素类似物（SSAs）治疗的神经内分泌肿瘤（NEN）患者已被描述存在外分泌胰腺功能不全（EPI），但其在这些患者的治疗管理中的作用尚未得到充分确立。
确定长期接受 SSAs 治疗的 NEN 患者中 EPI 的发生率。
这是一项前瞻性单中心研究，评估了 35 例因不可切除/晚期非胰腺高分化 NEN 而接受 SSAs 治疗>12 个月的患者。通过临床评估、生化参数和粪便弹性蛋白酶 1（FE-1）评估来诊断 EPI。
共有 7 名患者（20%）存在 EPI，这些患者存在腹部症状，粪便 FE-1 值中位数为 180 mcg/g 粪便（150-198）。没有患者存在严重的 EPI，即 FE-1 < 100 mcg/g 粪便。糖化 Hb 水平升高是发生 EPI 的显著预测因素（OR 4.81，p=0.01）。诊断为 EPI的患者与未诊断为 EPI 的患者之间接受 SSAs 治疗的持续时间无显著差异（分别为 84 个月和 72 个月；p=0.950）。
长期接受 SSAs 治疗的患者中，轻度至中度 EPI 是一种相对常见的情况。应计划对这些患者进行特定的临床和生化评估，包括 FE-1，以早期诊断这种相关情况，因为这可能会降低生活质量并导致营养不良。
