Despite evidence-based guidelines, exocrine pancreatic insufficiency is frequently
underdiagnosed and undertreated in patients with chronic pancreatitis. Therefore,
the aim of this study is to provide insight into the current opinion and clinical
decision-making of international pancreatologists regarding the management of exocrine
pancreatic insufficiency.An online survey and case vignette study was sent to experts
in chronic pancreatitis and members of various pancreatic associations: EPC, E-AHPBA
and DPSG. Experts were selected based on publication record from the past 5 years.Overall,
252 pancreatologists participated of whom 44% had ≥ 15 years of experience and 35%
treated ≥ 50 patients with chronic pancreatitis per year. Screening for exocrine pancreatic
insufficiency as part of the diagnostic work-up for chronic pancreatitis is performed
by 69% and repeated annually by 21%. About 74% considers nutritional assessment to
be part of the standard work-up. Patients are most frequently screened for deficiencies
of calcium (47%), iron (42%), vitamin D (61%) and albumin (59%). In case of clinically
steatorrhea, 71% prescribes enzyme supplementation. Of all pancreatologists, 40% refers
more than half of their patients to a dietician. Despite existing guidelines, 97%
supports the need for more specific and tailored instructions regarding the management
of exocrine pancreatic insufficiency.This survey identified a lack of consensus and
substantial practice variation among international pancreatologists regarding guidelines
pertaining the management of exocrine pancreatic insufficiency. These results highlight
the need for further adaptation of these guidelines according to current expert opinion
and the level of available scientific evidence.