Skip to main content

Advertisement

SpringerLink
Log in

Combined Endoscopic Ultrasound and Secretin Endoscopic Pancreatic Function Test in Patients Evaluated for Chronic Pancreatitis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Endoscopic ultrasound and endoscopic secretin pancreatic function test may be combined in a single endoscopic session (EUS/ePFT) to diagnose chronic pancreatitis (CP).

Aims

Our primary aim was to assess the correlation and concordance of combined EUS and secretin ePFT bicarbonate results in suspected minimal change CP.

Methods

Radial EUS included scoring for nine criteria (normal <4 criteria) with endoscopic collection of duodenal samples at 15, 30, and 45 min after secretin stimulation (normal peak bicarbonate ≥80 mmol/l).

Results

Three hundred and two patients completed the EUS/ePFT (252 for suspected minimal change CP, 38 for established CP, 12 for painless steatorrhea). In patients evaluated for suspected minimal change CP, a moderate negative correlation was observed between endoscopic ultrasound score and peak bicarbonate (r = −0.38, P < 0.001). The EUS and ePFT results were 76% concordant and 24% discordant. The ePFT was 85% sensitive and EUS was 100% sensitive for detecting patients with established calcific CP. The EUS/ePFT diagnosed CP in two of 12 of patients evaluated for painless steatorrhea or diarrhea with weight loss.

Conclusions

The combined EUS/ePFT is feasible and safe. There is only moderate correlation and concordance of endoscopic ultrasound and endoscopic pancreatic function test results in patients with suspected minimal change CP. The EUS and ePFT results produce complimentary functional and structural information for the evaluation of CP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CI:

Confidence interval

CP:

Chronic pancreatitis

CT:

Computed tomography

EUS:

Endoscopic ultrasound

ePFT:

Endoscopic pancreatic function test

mmol/l:

Millimoles per liter

NPV:

Negative predictive value

PFT:

Pancreatic function test

PPV:

Positive predictive value

References

  1. Walsh TN, Rode J, Theis BA, et al. Minimal change chronic pancreatitis. Gut. 1992;33:1566.

    Article  CAS  PubMed  Google Scholar 

  2. Wiersema MJ, Hawes RH, Lehman GA, et al. Prospective evaluation of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in patients with chronic abdominal pain of suspected pancreatic origin. Endoscopy. 1993;25:555–564.

    Article  CAS  PubMed  Google Scholar 

  3. Varadarajulu S, Eltoum I, Tamhane A, Eloubeidi MA. Histopathologic correlates of noncalcific chronic pancreatitis by EUS: a prospective tissue characterization study. Gastrointest Endosc. 2007;66:501–509.

    Article  PubMed  Google Scholar 

  4. Stevens T, Conwell DL, Zuccaro G, et al. A randomized crossover study of secretin-stimulated endoscopic and Dreiling-tube pancreatic function test methods in healthy subjects. Am J Gastroenterol. 2005;101:351–355.

    Article  Google Scholar 

  5. Stevens T, Conwell DL, Zuccaro G, et al. Prospective crossover study comparing secretin-stimulated endoscopic and Dreiling tube pancreatic function testing in patients evaluated for chronic pancreatitis. Gastrointest Endosc. 2008;67:458–466.

    Article  PubMed  Google Scholar 

  6. Wallace MB, Hawes RH, Durkalski V, et al. The reliability of EUS for the diagnosis of chronic pancreatitis: interobserver agreement among experienced endosonographers. Gastrointest Endosc. 2001;53:294–299.

    CAS  PubMed  Google Scholar 

  7. Draganov P, Toskes PP. Chronic pancreatitis. Curr Opin Gastroenterol. 2002;18:558–562.

    Article  CAS  PubMed  Google Scholar 

  8. Forsmark CE. The diagnosis of chronic pancreatitis. Gastrointest Endosc. 2000;52:293–298.

    Article  CAS  PubMed  Google Scholar 

  9. Malfertheiner P, Buchler M, Stanescu A, et al. Exocrine pancreatic function in correlation to ductal and parenchymal morphology in chronic pancreatitis. Hepatogastroenterol. 1986;33:110–114.

    CAS  Google Scholar 

  10. Lankisch PG, Seidensticker F, Otto J, et al. Secretin-pancreozymin test and endoscopic retrograde cholangiopancreatography: both are necessary for diagnosing or excluding chronic pancreatitis. Pancreas. 1996;12:149–152.

    Article  CAS  PubMed  Google Scholar 

  11. Clain JE, Pearson RK. Diagnosis of chronic pancreatitis. Is a gold standard necessary? Surg Clin N Am. 1999;79:829–845.

    Article  CAS  PubMed  Google Scholar 

  12. Forsmark CE, Toskes PP. What does an abnormal pancreatogram mean? Gastrointest Endosc Clin N Am. 1995;5:105–122.

    CAS  PubMed  Google Scholar 

  13. Stevens T, Dumot JA, Zuccaro G, et al. Evaluation of duct-cell and acinar-cell function and endosonographic abnormalities in patients with suspected chronic pancreatitis. Clin Gastroenterol Hepatol. 2009;7:114–119.

    Article  PubMed  Google Scholar 

  14. Chowdhury RS, Forsmark CE. Review article: pancreatic function testing. Aliment Pharmacol Ther. 2003;17:733–750.

    Article  CAS  PubMed  Google Scholar 

  15. Chowdhury R, Bhutani MS, Mishra G, et al. Comparative analysis of direct pancreatic function testing versus morphological assessment by endoscopic ultrasonography for the evaluation of chronic unexplained abdominal pain of presumed pancreatic origin. Pancreas. 2005;31:63–68.

    Article  PubMed  Google Scholar 

  16. Wiersema MJ, Wiersema LM. Endosonography of the pancreas: normal variation vs. changes of early chronic pancreatitis. Gastrointest Endosc Clin N Am. 1995;5:487–496.

    CAS  PubMed  Google Scholar 

  17. Rajan E, Clain JE, Levy MJ, et al. Age-related changes in the pancreas identified by EUS: a prospective evaluation. Gastrointest Endosc. 2005;61:401–406.

    Article  PubMed  Google Scholar 

  18. Teichmann J, Mann ST, Stracke H, et al. Alterations of vitamin D3 metabolism in young women with various grades of chronic pancreatitis. Eur J Med Res. 2007;16:347–350.

    Google Scholar 

  19. Mann ST, Stracke H, Lange U, et al. Alterations of bone mineral density and bone metabolism in patients with various grades of chronic pancreatitis. Metabolism. 2003;52:579–585.

    Article  CAS  PubMed  Google Scholar 

  20. Iordache S, Saftoiu A, Cazacu S, et al. Endoscopic ultrasound approach of pancreatic cancer in chronic pancreatitis patients in a tertiary referral center. J Gastrointestin Liver Dis. 2008;17:279–284.

    PubMed  Google Scholar 

  21. Irisawa A, Katakura K, Ohira H, et al. Usefulness of endoscopic ultrasound to diagnose the severity of chronic pancreatitis. J Gastroenterol. 2007;42:90–94.

    Article  PubMed  Google Scholar 

  22. Das A, Nguyen CC, Li F, Li B. Digital image analysis of EUS images accurately differentiates pancreatic cancer from chronic pancreatitis normal tissue. Gastrointest Endosc. 2008;67:861–867.

    Article  PubMed  Google Scholar 

  23. Saftoiu A, Vilmann P, Gorunescu F, et al. Neural network analysis of dynamic sequences of EUS elastography used for the differential diagnosis of chronic pancreatitis and pancreatic cancer. Gastrointest Endosc. 2008;68:1086–1094.

    Article  PubMed  Google Scholar 

  24. Lieb JG, Draganov P. Pancreatic function testing: here to stay for the 21st century. World J Gastroenterol. 2008;14:3149–3158.

    Article  PubMed  Google Scholar 

  25. Catalano MF, Sahai A, Levy M, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc. 2009;69:1251–1261.

    Article  PubMed  Google Scholar 

  26. Forsmark CE. The early diagnosis of chronic pancreatitis. Clin Gastroenterol Hepatol. 2008;6:1291–1293. Editorial.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Digestive Disease Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A31, Cleveland, OH, 44195, USA

    Tyler Stevens, John A. Dumot, Mansour A. Parsi, Gregory Zuccaro & John J. Vargo

Authors
  1. Tyler Stevens
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John A. Dumot
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mansour A. Parsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gregory Zuccaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John J. Vargo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tyler Stevens.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stevens, T., Dumot, J.A., Parsi, M.A. et al. Combined Endoscopic Ultrasound and Secretin Endoscopic Pancreatic Function Test in Patients Evaluated for Chronic Pancreatitis. Dig Dis Sci 55, 2681–2687 (2010). https://doi.org/10.1007/s10620-009-1084-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-009-1084-x

Keywords

Search

Navigation