Endoscopic Pancreatic Function Testing (ePFT) in Children

Patel, Nishant; Sellers, Zachary M.; Grover, Amit S.; Liu, Quin Y.; Maqbool, Asim; Morinville, Véronique D.; Abu‐El‐Haija, Maisam; Husain, Sohail Z.

doi:10.1097/mpg.0000000000002931

Cited by 14 publications

(11 citation statements)

References 51 publications

(72 reference statements)

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“…More frequently, endoscopic testing with CCK or secretin stimulation is performed. 2 , 92 , 98 , 104 Direct tests have higher sensitivity and specificity but are expensive and not available at all centers. Here, measurement of pancreatic enzymes and bicarbonate via endoscopic collection and testing can be done but mostly at tertiary centers.…”

Section: Diagnosis Of Epimentioning

confidence: 99%

Exocrine Pancreatic Insufficiency in Children – Challenges in Management

Sankararaman,

Schindler

2023

PHMT

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Cystic fibrosis (CF) is the leading etiology for exocrine pancreatic insufficiency (EPI) in children, followed by chronic pancreatitis, Shwachman-Diamond syndrome, and other genetic disorders. Management of EPI in children poses several unique challenges such as difficulties in early recognition, lack of widespread availability of diagnostic tests and limited number of pediatricspecific pancreatic centers. Pancreatic enzyme replacement therapy is the cornerstone of EPI management and in young children difficulties in administering pancreatic enzymes are frequently encountered. Patients with EPI also should be screened for fat-soluble vitamin deficiencies and receive appropriate supplementation. Among disorders with EPI in children, CF is the relatively well-studied condition, and most management recommendations for EPI in children come from expert consensus and conventional practice guidelines. The impact of EPI can be greater in children given their high metabolic demands and rapid growth. Early diagnosis and aggressive management of EPI prevent consequences of complications such as malnutrition, fat-soluble vitamin deficiencies, and poor bone health and improve outcomes. Management by multi-disciplinary team is the key to success.

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Section: Diagnosis Of Epimentioning

confidence: 99%

Exocrine Pancreatic Insufficiency in Children – Challenges in Management

Sankararaman,

Schindler

2023

PHMT

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“…ePFT is less time consuming, does not result in patient's discomfort as performed during sedation, and eliminates need for radiation exposure. The limitations of ePFT include lack of uniformly accepted protocol, and requirement of anesthesia to perform ( 143 ). See list of advantages and limitations to ePFT in Table 4 .…”

Section: Direct (Stimulatory) Exocrine Function Testsmentioning

confidence: 99%

Assessment of exocrine pancreatic function in children and adolescents with direct and indirect testing

et al. 2022

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The exocrine pancreas plays an important role in digestion. Understanding of the physiology and regulation of exocrine function provides insight into disease processes and basis of functional testing. Specifically, exocrine pancreatic insufficiency (EPI) can cause maldigestion and thus a proper assessment of exocrine pancreatic function is important. There are indirect and direct methods for evaluating pancreatic function. Indirect methods are varied and include stool, serum, urine, and breath tests. Fecal elastase is a commonly used indirect test today. Direct methods involve stimulated release of pancreatic fluid that is collected from the duodenum and analyzed for enzyme activity. The most used direct test today is the endoscopic pancreatic function test. Indirect pancreatic function testing is limited in identifying cases of mild to moderate EPI, and as such in these cases, direct testing has higher sensitivity and specificity in diagnosing EPI. This review provides a comprehensive guide to indirect and direct pancreatic function tests as well as an in-depth look at exocrine pancreatic function including anatomy, physiology, and regulatory mechanisms.

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“…EUS with secretin stimulation (sEUS) has been utilized to assess for structural changes reflective of minimal change chronic pancreatitis (MCCP), and can impact the likelihood of CP following, and predict progression of MCCP to overt CP in patients with abdominal pain thought to be pancreatic in origin with non-diagnostic cross-sectional imaging ( 41 , 42 ). A multicenter research collaboration is needed to further refine and validate the proposed methods ( 43 ).…”

Section: Endoscopic Pancreatic Function Testingmentioning

confidence: 99%