Abbreviated 13C-mixed triglyceride breath test for detection of pancreatic exocrine insufficiency performs equally as standard 5-hour test in patients after gastrectomy performed for gastric cancer

Siuka, Darko; Kumer, Kristina; Stabuc, Borut; Stubljar, David; Drobne, David; Jansa, Rado

doi:10.2478/raon-2022-0034

Figures & Tables

Receiver operating characteristic (ROC) curves for respective time points of breathing test for all subjects.
NPV = negative predictive values; PPV = positive predictive values; Sens = sensitivity; Spec = specificity — Receiver operating characteristic (ROC) curves for respective time points of breathing test for all subjects. NPV = negative predictive values; PPV = positive predictive values; Sens = sensitivity; Spec = specificity

Differences between patient with positive and negative pancreatic exocrine insufficiency (PEI) determined by 13C-mixed triglyceride breath*

	PEI		p-value
	Positive < 26.8 (n = 22)	Negative > 26.8 (n = 43)	p-value
Sex
Male/Female	16/6	22/21	0.095
Age [years]	63.5 ± 12.8	57.2 ± 18.5	0.157
Weight [kg]	72.8 ± 15.8	65.5 ± 14.7	0.069
Height [m]	1.7 ± 0.1	1.7 ± 0.1	0.447
BMI	24.4 ± 4.0	22.5 ± 4.1	0.082
Smoking			0.181
No	17 (77.3%)	39 (90.7%)
< 15/day	3 (13.6%)	(2.3%)
15/day	2 (9.1%)	3 (7.0%)
Coffee			0.107
No	9 (40.9%)	14 (32.6%)
1−2/day	12 (54.5%)	17 (39.5%)
> 2/day	1 (4.5%)	11 (25.6%)
Alcohol			0.527
No	14 (63.6%)	33 (76.7%)
< 2 units/day	7 (31.8%)	9 (20.9%)
> 2 units/day	1 (4.5%)	1 (2.3%)
Cholesterol	4.5 ± 0.8	4.4 ± 0.8	0.523
HDL_cholesterol	1.3 ± 0.4	1.5 ± 0.5	0.091
LDL_cholesterol	2.6 ± 0.8	2.5 ± 0.6	0.630
Triglycerides	1.6 ± 1.0	1.0 ± 0.6	0.011

Cut-off values for prediction of non-pancreatic exocrine insufficiency (non-PEI) within respective timepoints in all subjects

	All patients
	cut-off	AUC	95% CI	p-value	Sensitivity	Specificity	PPV	NPV
30 min	0.25	0.591	0.444−0.737	0.233	53.5%	68.2%	42.9%	76.7%
60 min	1.16	0.662	0.522−0.801	0.034	67.4%	54.5%	46.2%	74.4%
90 min	3.79	0.776	0.654−0.898	< 0.001	67.4%	81.8%	56.3%	87.9%
120 min	4.71	0.845	0.738−0.952	< 0.001	88.4%	72.7%	76.2%	86.4%
150 min	13.74	0.929	0.853−1.000	< 0.001	93.0%	90.9%	87.0%	95.2%
180 min	16.19	0.938	0.869−1.000	< 0.001	93.0%	90.9%	87.0%	95.2%
210 min	18.64	0.948	0.888−1.000	< 0.001	95.3%	90.9%	90.9%	95.3%
240 min	20.85	0.962	0.902−1.000	< 0.001	97.7%	90.9%	95.2%	95.5%
270 min	25.71	0.962	0.891−1.000	< 0.001	97.7%	95.5%	95.5%	97.7%
300 min	26.95	0.962	0.889−1.000	< 0.001	100%	95.5%	100%	97.7%

Basic characteristics of subjects enrolled in the study

	All subjects N = 65	Healthy controls N = 20	Subtotal resection N = 23	Total resection N = 22	p-value
Sex M/F	38 (58.5%)/27 (41.5%)	7/13	14/9	17/5	0.020
Age [years]	59.3 ± 16.9	43.4 ± 13.4	62.7 ± 13.8	70.2 ± 11.4	< 0.001
Age group					< 0.001
18−40 y	8 (12.3%)	7 (35.0%)	1 (4.3%)	0
41−65 y	35 (53.8%)	13 (65.0%)	15 (65.3%)	7 (31.8%)
> 65 let	22 (33.8%)	0	7 (30.4%)	15 (62.2%)
Weight [kg]	67.9 ± 15.3	66.6 ± 16.0	70.0 ± 13.7	67.0 ± 16.8	0.738
Height [m]	1.7 ± 0.1	1.7 ± 0.1	1.7 ± 0.1	1.7 ± 0.1	0.576
BMI	23.2 ± 4.2	22.3 ± 4.3	24.1 ± 4.0	23.0 ± 4.2	0.333
PEI (< 26.8)^#	22 (33.8%)	0	11 (47.8%)	11 (50.0%)	0.001
Pancreatic elastase (mcg/g)	349.8 ± 182.1	440.2 ± 126.3	312.2 ± 188.8	307.0 ± 195.2	0.026
Normal	50 (76.9%)	20 (100%)	16 (69.6%)	14 (63.6%)
Mild decrease	7 (10.8%)	0	2 (8.7%)	5 (22.7%)
Moderate decrease	2 (3.1%)	0	2 (8.7%)	0
Severe decrease	6 (9.2%)	0	3 (13.0%)	3 (13.6%)
Chymotrypsin (U/g)	225.3 ± 160.8	301.7 ± 187.4	181.9 ± 130.3	201.3 ± 144.8	0.033
Normal	52 (80.0%)	20 (100%)	14 (60.9%)	18 (81.8%)
PEI	13 (20.0%)	0	9 (39.1%)	4 (18.2%)
Smoking					0.445
No	56 (86.2%)	19 (95.0%)	18 (78.3%)	19 (86.4%)
< 15 cigarettes /day	4 (6.2%)	0	3 (13.0%)	1 (4.5%)
> 15 cigarettes /day	5 (7.7%)	1 (5.0%)	2 (8.7%)	2 (9.1%)
Coffee					0.136
No	23 (35.4%)	4 (20.0%)	7 (30.4%)	12 (54.5%)
1−2 cups /day	29 (44.6%)	10 (50.0%)	12 (52.2%)	7 (31.8%)
> 2 cups /day	12 (18.5%)	6 (30.0%)	3 (13.0%)	3 (13.6%)
Alcohol					0.108
No	47 (72.3%)	12 (60.0%)	15 (65.2%)	17 (77.3%)
< 2 units/day	16 (24.6)	8 (40.0%)	5 (21.7%)	3 (13.6%)
> 2 units/day	2 (3.1%)	0	0	2 (9.1%)
Cholesterol (mmol/l)	4.5 ± 0.8	4.5 ± 0.7	4.4 ± 1.0	4.5 ± 0.7	0.736
HDL_cholesterol	1.5 ± 0.5	1.5 ± 0.4	1.4 ± 0.4	1.5 ± 0.6	0.637
LDL_cholesterol	2.5 ± 0.7	2.5 ± 0.6	2.5 ± 0.8	2.5 ± 0.7	0.921
Triglycerides	1.2 ± 0.8	0.9 ± 0.2	1.2 ± 0.9	1.5 ± 0.9	0.033

Percent of exhaled 13C in patients with pancreatic exocrine insufficiency (PEI) and without PEI at respective timepoint of 13C measurement

	PEI		p-value*
	Positive < 26.8 (n = 22)	Negative > 26.8 (n = 43)	p-value*
30 min	0.29 ± 0.71	0.47 ± 0.62	0.233
60 min	0.97 ± 1.87	2.23 ± 2.00	0.034
90 min	2.05 ± 2.96	5.23 ± 3.24	< 0.001
120 min	3.53 ± 3.94	8.85 ± 4.05	< 0.001
150 min	8.39 ± 6.36	20.88 ± 5.96	< 0.001
180 min	10.12 ± 7.03	25.07 ± 6.63	< 0.001
210 min	12.21 ± 7.37	29.33 ± 7.29	< 0.001
240 min	14.50 ± 7.66	33.52 ± 8.06	< 0.001
270 min	17.10 ± 8.25	37.33 ± 9.09	< 0.001
300 min	17.72 ± 9.44	40.76 ± 10.43	< 0.001

Percent of exhaled 13C according to diagnosis of in respective timepoint of C13 measurement

	Healthy controls (n = 20)	Diagnosis		p-value*	p-value**
	Healthy controls (n = 20)	Subtotal resection (n = 23)	Total resection (n = 22)	p-value*	p-value**
30 min	0.54 ± 0.74	0.32 ± 0.71	0.38 ± 0.51	0.700	0.936
60 min	2.28 ± 2.32	1.27 ± 1.88	1.92 ± 1.86	0.193	0.534
90 min	5.12 ± 3.76	3.15 ± 3.12	4.32 ± 3.45	0.202	0.495
120 min	8.63 ± 4.76	5.669 ± 4.54	7.04 ± 4.63	0.162	0.593
150 min	20.60 ± 7.09	13.96 ± 9.00	15.87 ± 8.11	0.056	0.714
180 min	24.91 ± 7.86	16.94 ± 10.74	18.77 ± 9.00	0.031	0.790
210 min	29.31 ± 8.61	20.45 ± 12.33	21.51 ± 9.55	0.023	0.937
240 min	33.67 ± 9.26	24.18 ± 13.81	24.14 ± 10.11	0.014	1.000
270 min	37.71 ± 9.82	28.04 ± 15.26	26.47 ± 10.63	0.010	1.000
300 min	41.14 ± 10.40	32.01 ± 17.21	28.51 ± 11.00	0.008	0.658

Abbreviated 13C-mixed triglyceride breath test for detection of pancreatic exocrine insufficiency performs equally as standard 5-hour test in patients after gastrectomy performed for gastric cancer

Figures & Tables

Figure 1

Differences between patient with positive and negative pancreatic exocrine insufficiency (PEI) determined by 13C-mixed triglyceride breath*

Cut-off values for prediction of non-pancreatic exocrine insufficiency (non-PEI) within respective timepoints in all subjects

Basic characteristics of subjects enrolled in the study

Percent of exhaled 13C in patients with pancreatic exocrine insufficiency (PEI) and without PEI at respective timepoint of 13C measurement

Percent of exhaled 13C according to diagnosis of in respective timepoint of C13 measurement

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