Systematic reviews and meta-analysesDiagnostic Performance of Measurement of Fecal Elastase-1 in Detection of Exocrine Pancreatic Insufficiency: Systematic Review and Meta-analysis
Section snippets
Search Strategy
We searched PubMed and Embase from inception through November 2016 for relevant studies using a combination of MeSH terms and keywords according to PRISMA guidelines.22 The search terms were (Pancreatic elastase[tiab] OR fecal elastase[tiab] OR faecal elastase[tiab] OR pancreatic function tests[mesh:noexp]) AND (exocrine pancreatic insufficiency [mesh: noexp] OR pancreatic insufficiency [tiab]). We did not use any search restrictions. Two authors (R.R.V. and S.S.) independently screened studies
Results of the Search
We identified a total of 616 studies (Figure 1), of which, only 20 studies (19 papers and 1 abstract) that were published fulfilled the inclusion criteria and were included in the review (Tables 1 and 2). All 20 studies were observational. A total of 8 different countries were represented. Nine studies evaluated adults only, 10 studies evaluated both adults and children, and 1 study evaluated children only. In FE-1 versus secretin stimulation test analysis of 14 studies, data on 1101 patients
Discussion
This is the first study in the English literature to perform a systematic review and meta-analysis of the diagnostic utility of FE-1 in EPI. Based on our review, the pooled sensitivity and specificity of FE-1 versus secretin stimulation test when all 16 studies were included was 0.77 (95% CI, 0.58–0.89) and 0.88 (95% CI, 0.78–0.93), respectively, and diagnostic accuracy was 23 (95% CI, 6–84). This diagnostic accuracy was maintained when several sensitivity analyses were performed, as shown in
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Conflicts of interest The authors disclose no conflicts.
Funding Aylin Tansel is supported by the National Institutes of Health (grant T-32 5T32DK083266-07). This work is funded in part by the Texas Digestive Disease Center (National Institutes of Health grant DK58338). Dr. El-Serag is also supported by the National Institute of Diabetes and Digestive and Kidney Diseases (K24-04-107).