P4664 - The Prevalence of Low Fecal Elastase Among Patients With Pancreatic Adenocarcinoma

Chukwuemeka E. Ogbu, MD, MPH¹, Chukwunonso Ezeani, MBBS², Bishoy Lawendy, MD³, Tayyaba Bhatti, MD³, Oyedotun Babajide, MD⁴, Michael Youssef, MD⁵, Deborah Adekunle, MD⁶, Philip Okafor, MD⁷, Osayande Osagiede, MBBS, MPH^7
1Cape Fear Valley Health, Fayetteville, NC; ²Baton Rouge General Medical Center, Baton Rouge, LA; ³Western University, London, ON, Canada; ⁴New York Medical College Metropolitan Hospital, New York, NY; ⁵University of Toronto, Ontario, ON, Canada; ⁶Washington University School of Medicine in St. Louis / Barnes-Jewish Hospital, St. Louis, MO; ⁷Mayo Clinic, Jacksonville, FL

Introduction: Pancreatic adenocarcinoma (PDAC) accounts for approximately 3% of all cancers in the United States. PDAC is often diagnosed at an advanced stage, leading to poor prognosis and high mortality rates. About 1% of patients with diabetes mellitus (DM) aged >= 50 years will be diagnosed with PDAC within 3 years and this is believed to be due to exocrine dysfunction from PDAC. A low fecal elastase is associated with exocrine dysfunction of the pancreas. We hypothesize that a low fecal elastase, either alone or in combination with glycemic indices, could enrich the population at risk for PDAC, enabling earlier detection.

Methods: We retrospectively analyzed the characteristics and outcomes of PDAC patients at all Mayo Clinic sites who had fecal elastase levels checked. The study population consisted of 66 PDAC patients, categorized based on their fecal elastase (FE) levels: < 200 μg/g (suggestive of EPI) and >200 μg/g. We assessed various demographic, clinical, and treatment-related variables. Continuous variables were expressed as means and standard deviations and compared with the independent sample Students' T-test. Categorical variables were expressed as percentages and compared using Chi-squared testing.

Results: Among the 66 PDAC patients, 49 (74.2%) had fecal elastase < 200 μg/g while 17 (25.8%) had levels >200 μg/g. Mean age at diagnosis was 64.8 years, with females accounting for 51.5% of the study sample. About 91% of study participants were White. Mortality rate was 50.0%, with a mean survival of 3.2 years. Diabetes was present in 48.5% of patients, predominantly type 2 (90.0%). Mean hemoglobin A1C (HbA1C) and fasting blood glucose (FBG) were 8.0% and 161 mg/dl respectively. Pancreatic enzyme replacement therapy was used by 78.8% of patients. FE indications included diarrhea (59.1%), weight loss (31.8%), abdominal pain (9.1%), and bloating (1.5%). The mean FE was 151.8 μg/g. Imaging confirmed a cancer mass in 97.0% of patients, with tumor locations primarily in the head (53.0%), body (24.2%), and tail (13.7%) of the pancreas. The majority of patients were diagnosed at AJCC stage 4 (37.9%) or with metastatic disease (42.4%). Surgery was performed in 45.5% of patients, while 78.8% received chemotherapy, with or without radiation therapy.

Discussion: The prevalence of a low fecal elastase in PDAC patients is high and could serve as a biomarker for early detection. More research is needed to explore the interactions between fecal elastase and glycemic indices in patients with PDAC.


Disclosures:


Chukwuemeka E. Ogbu, MD, MPH¹, Chukwunonso Ezeani, MBBS², Bishoy Lawendy, MD³, Tayyaba Bhatti, MD³, Oyedotun Babajide, MD⁴, Michael Youssef, MD⁵, Deborah Adekunle, MD⁶, Philip Okafor, MD⁷, Osayande Osagiede, MBBS, MPH⁷. P4664 - The Prevalence of Low Fecal Elastase Among Patients With Pancreatic Adenocarcinoma, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.