Di Martino Marcello, de la Hoz Rodriguez Ángela, Saibanti Andrea, Salvador Camarmo Guillermo, Pagano Nico, Martín-Pérez Elena, Donadon Matteo
Department of Health Sciences, University of Piemonte Orientale, Novara, 28100, Italy.
Division of Surgery, University Maggiore Hospital della Carità, Corso Mazzini 18, Novara, 28100, Italy.
BMC Surg. 2025 Feb 3;25(1):53. doi: 10.1186/s12893-025-02787-y.
Pancreatic exocrine insufficiency (PEI) is a condition defined by a reduction in pancreatic exocrine activity that impairs normal digestion. Despite established guidelines recommendations, precise diagnosis of PEI after pancreatic resection are infrequently achieved. This review aims to provide a comprehensive overview of the methodology and accuracy of diagnostic tools available for evaluating PEI after pancreatic resection.
A review of PEI diagnostic tests was conducted using a combined text and MeSH search strategy to identify relevant articles focused on post-pancreatectomy PEI diagnosis.
The literature search yielded 4,874 records, and 30 studies were included in the analysis, with a total of 2,305 patients. The reported frequency of PEI across the included studies varied widely, though more than two-thirds of included papers reported an incidence of PEI above 65% in patients who underwent pancreatoduodenectomy or distal pancreatectomy. The faecal elastase-1 (FE-1) test was the most frequently used test for diagnosing post-pancreatectomy PEI. Six studies compared the diagnostic accuracy of FE-1 with faecal fat tests or 13 C breath tests, finding no significant differences. Five studies reported on micronutrient deficiencies.
The FE-1 test is the most commonly used diagnostic tool for post-pancreatectomy PEI; however, well-designed studies comparing the diagnostic accuracy of various tests for PEI are lacking. Additionally, few studies report on micronutrient deficiencies, variations in anthropometric data or PEI-related patient-reported outcomes. Future studies should aim to establish a gold standard for diagnosis and severity assessment of post-pancreatectomy PEI and provide guidance for tailored pancreatic enzyme replacement therapy.
胰腺外分泌功能不全（PEI）是一种因胰腺外分泌活动减少而损害正常消化功能的病症。尽管有既定的指南建议，但胰腺切除术后PEI的准确诊断却很少能实现。本综述旨在全面概述可用于评估胰腺切除术后PEI的诊断工具的方法和准确性。
采用文本和医学主题词（MeSH）相结合的检索策略对PEI诊断试验进行综述，以识别专注于胰腺切除术后PEI诊断的相关文章。
文献检索共获得4874条记录，纳入分析的研究有30项，涉及患者共2305例。在所纳入的研究中，报告的PEI发生率差异很大，不过超过三分之二的论文报告，接受胰十二指肠切除术或远端胰腺切除术患者的PEI发生率高于65%。粪便弹性蛋白酶-1（FE-1）检测是诊断胰腺切除术后PEI最常用的检测方法。六项研究比较了FE-1与粪便脂肪检测或13C呼气试验的诊断准确性，未发现显著差异。五项研究报告了微量营养素缺乏情况。
FE-1检测是胰腺切除术后PEI最常用的诊断工具；然而，缺乏比较各种PEI检测诊断准确性的精心设计的研究。此外，很少有研究报告微量营养素缺乏、人体测量数据变化或PEI相关的患者报告结局。未来的研究应致力于建立胰腺切除术后PEI诊断和严重程度评估的金标准，并为量身定制的胰酶替代疗法提供指导。
