We evaluated clinical significance of fecal elastase-1(FE-1) in patients with pancreatic diseases and pancreatic dysfunction, in comparison with other tubeless test and secretin test.
Patients and Methods ; FE-1 was determined in healthy controls(n＝131), chronic pancreatitis(CP)(n＝52), acute pancreatitis(AP)(n＝14), pancreatic cyst(Pcyst)(n＝20), pancreatic cancer(Pca)(n＝12), post pancreatic surgery(post P)(n＝28), biliary diseases(B)(n＝6), and gastro-duodenal ulcer(G)(n＝6). Fecal chymotrypsin(FCT) and BT-PABA test were performed in those patients digestive diseases. Secretin test collecting duodenal juice through a duodenal tube was performed in only 65 patients described above.
Results ; FE-1 was 1504±100μg/g(M±SE) in healthy controls. Using a cut off of 200μg/g, 94.6% for healthy controls had FE-1 above this limit. FE-1 was 517±106μg/g in CP, 1802±437μg/g in AP, 525±109μg/g in Pcyst, 528±126μg/g in Pca, 135±36mg/g in post P, 1435± 506μg/g in B, and 1115±325μg/g in G, respectively.
Sensitivity in the diagnosis of CP was 51.9%, 46.2% and 54.8% for FE-1, FCT, and BT-PABA test, respectively.
Specificity of FE-1 and FCT was 81.3% and 78.7%, while that of BT-PABA test was 44.4%. Significant correlation was observed between FE-1 and secretory data including juice volume, maximum HCO3− concentration, and amylase output obtained form secretin test.
In diagnosis of severe pancreatic dysfunction classified based on secretin test, the sensitivity was 86.7% for FE-1, 66.7% for FCT, and 66.7% for BT-PABA test. The specificity was also 70.0%, 80.0%, and 54.3%, for FE-1, FCT, and BT-PABA test, respectively.
Conclusion ; These results indicate that FE-1 may be recommended as a new, noninvasive tubeless test of pancreatic function.

*1Central Clinical Laboratories, Tokyo Women's Medical University, Tokyo 162-8666