Can a patient with chronic pancreatitis and symptoms of left upper quadrant pain and steatorrhea have a fibroscan of the pancreas?

FibroScan Cannot Be Used to Evaluate the Pancreas

FibroScan (transient elastography) is not a validated or available modality for assessing pancreatic tissue and cannot be performed on the pancreas. This technology is specifically designed and FDA-approved for liver stiffness measurement, not pancreatic evaluation.

Why FibroScan Is Not Applicable to the Pancreas

• FibroScan uses vibration-controlled transient elastography to measure liver stiffness through the intercostal spaces, with the probe positioned to target hepatic tissue specifically 1
• The pancreas is located deep in the retroperitoneum, making it inaccessible to the surface-based transient elastography technique used by FibroScan 1
• No clinical guidelines or research evidence supports the use of FibroScan for pancreatic assessment in any context, including chronic pancreatitis 2

Appropriate Imaging Modalities for Chronic Pancreatitis

For your patient with chronic pancreatitis presenting with left upper quadrant pain and steatorrhea, the following diagnostic approaches are evidence-based:

First-Line Imaging

• Contrast-enhanced CT is the best initial imaging modality for diagnosing chronic pancreatitis, with high diagnostic specificity for detecting calcifications, ductal dilatation, and pancreatic atrophy 3, 4
• CT findings typically appear in advanced stages of disease and may be inconclusive in early chronic pancreatitis 1, 5

Advanced Imaging Options

• Endoscopic ultrasound (EUS) provides superior spatial resolution compared to CT and MRI and is considered the most reliable diagnostic modality for pancreatic diseases 1, 5
• EUS can detect both parenchymal and ductal changes at early stages of chronic pancreatitis 5
• The EUS-based Rosemont classification is the standard for diagnosing chronic pancreatitis in clinical practice 1

Emerging Elastography Techniques (Not FibroScan)

• MR elastography and EUS-based elastography can assess pancreatic tissue stiffness and fibrosis, but these are distinct from FibroScan technology 1
• These modalities are expected to provide alternative diagnostic tools for assessing fibrosis in chronic pancreatitis, though they remain investigational 1

Ductal Assessment

• Magnetic resonance cholangiopancreatography (MRCP) assesses pancreatic duct features non-invasively 1, 3
• ERCP provides detailed ductal imaging but carries risks including post-ERCP pancreatitis and should be reserved for therapeutic interventions 2, 1

Management of Your Patient's Symptoms

Given the presentation of steatorrhea indicating pancreatic exocrine insufficiency:

• Initiate pancreatic enzyme replacement therapy (PERT) immediately when clinical signs of malabsorption are present, including steatorrhea, weight loss, and left upper quadrant pain 2
• PERT should use pH-sensitive, enteric-coated microspheres that protect enzymes from gastric acidity 2
• Provide nutritional counseling with 35-40 kcal/kg/day and protein intake of 1.2-1.5 g/kg/day 6
• Screen for fat-soluble vitamin deficiencies (A, D, E, K) and micronutrients (calcium, magnesium, zinc, thiamine, folic acid) at least every 12 months 2, 6

Common Pitfalls to Avoid

• Do not attempt to use FibroScan for pancreatic assessment—it is not designed for this purpose and will provide no useful information
• Do not rely solely on CT in early disease, as sensitivity is limited; consider EUS if clinical suspicion remains high despite normal CT 1, 5
• Do not delay PERT initiation while awaiting definitive imaging—clinical signs of malabsorption (steatorrhea) are sufficient indication to begin treatment 2
• Do not use BMI alone for nutritional assessment, as it fails to detect sarcopenia in patients with chronic pancreatitis 2, 6