title: Value of magnetic resonance cholangiopancreatography with secretin stimulation in the evaluation of pancreatic exocrine function after pancreaticogastrostomy.
abstract: OBJECTIVE
  The aim of this study was to assess the value of magnetic resonance cholangiopancreatography with secretin stimulation (secretin-MRCP) in evaluating the remnant pancreatic exocrine reserve after pancreaticogastrostomy with pancreaticoduodenectomy.
  
  
  METHODS
  Forty-three patients who had undergone pancreaticoduodenectomies and who were given pancreaticogastrostomies for reconstruction were studied. Dynamic MRCPs, using a half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequence were obtained before and up to 10 min after secretin administration. The morphologic features and diameter of the main pancreatic duct were monitored and graded before and after secretin stimulation. The results were compared with those of endoscopic findings, secretin stimulation testing with a collection of pancreatic fluid, N-benzoyl- L-tyrosyl-p-aminobenzoic acid (BT-PABA) excretion testing, and fecal chymotrypsin concentration.
  
  
  RESULTS
  The results of secretin-MRCP were classified into three distinct groups: a good-secretion group (group 1; n=22; 51%), a moderate-secretion group (group 2; n=10; 23%), and a poor-secretion group (group 3; n=11; 26%). This MRCP classification correlated significantly with the concentrations of the pancreatic enzymes p-type amylase, lipase, and trypsin in the gastric juice. The BT-PABA test value was 59.8% in group 1, 46.1% in group 2, and 46.5% in group 3, and was significantly higher in group 1 than in groups 2 or 3. The fecal chymotrypsin concentration was 20.5 U/g in group 1, 14.5 U/g in group 2, and 0.7 U/g in group 3, and there was a significant correlation between the MRCP classification and fecal chymotrypsin concentration.
  
  
  CONCLUSIONS
  MRCP with secretin stimulation favorably reflected the presence of remnant pancreatic exocrine function. Therefore, secretin-MRCP is a feasible and effective follow-up examination method to evaluate remnant pancreatic exocrine function after pancreaticogastrostomy.
authors.affiliation: First Department of Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shinchi
authors.forename: Sonshin
authors.initials: S
authors.lastname: Takao
authors.forename: Kosei
authors.initials: K
authors.lastname: Maemura
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Fukukura
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Noma
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Matsuo
authors.forename: Yukou
authors.initials: Y
authors.lastname: Mataki
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Mori
authors.forename: Satoshi
authors.initials: S
authors.lastname: Iino
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Ehi
authors.forename: Takashi
authors.initials: T
authors.lastname: Aikou
mesh_terms: D010129:4-Aminobenzoic Acid; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D049448:Cholangiopancreatography, Magnetic Resonance; D005260:Female; D005750:Gastric Juice / Q000201:enzymology; D005774:Gastrostomy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D016577:Pancreaticoduodenectomy; D011184:Postoperative Period; D012633:Secretin; D062366:para-Aminobenzoates
chemical_list: D062366:para-Aminobenzoates; D012633:Secretin; C006717:bentiromide; D010129:4-Aminobenzoic Acid