title: A randomized crossover study of secretin-stimulated endoscopic and dreiling tube pancreatic function test methods in healthy subjects.
abstract: OBJECTIVE
  We have developed an endoscopic method of secretin endoscopic pancreatic function testing (ePFT) to simplify duodenal fluid collection. Validation of the ePFT requires a direct comparison to the traditional PFT using a Dreiling tube (DT). Our aim was to compare bicarbonate concentrations [HCO3-] obtained by the ePFT and DT methods in healthy subjects (HS).
  
  
  METHODS
  HS were randomized to either DT or ePFT, then crossed over to the other test after a minimum 1-wk washout. An age/weight-based sedation bolus was used for each test. DT protocol: Endoscopic placement of a DT was confirmed by fluoroscopy. After a baseline 15-min collection and administration of IV synthetic secretin, fluid was continuously collected in 15-min aliquots for an hour. ePFT protocol: Endoscopy was performed using a 6-mm endoscope. After gastric aspiration and discard and IV secretin, duodenal aspirates were obtained every 15-min for an hour. Fluid specimens were auto-analyzed for [HCO3-].
  
  
  RESULTS
  Twelve HS were enrolled (6F, mean age 37 yr). The difference in [HCO3-] between the two methods was not significant at the 0-, 30-, 45-, or 60-min collections. An excellent correlation in peak [HCO3-] was observed (R2 = 0.84, p < 0.001). Using a peak [HCO3-] cutpoint 80 mEq/L, there was 100% agreement between the methods; using cutpoint 90 mEq/L, there was 83% agreement.
  
  
  CONCLUSIONS
  The accuracy of the ePFT is similar to DT: There were minimal differences in [HCO3-] at each of the timed collections and at peak. There is an excellent correlation in peak [HCO3-] and high level of diagnostic agreement between the tests.
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Stevens
authors.forename: Darwin L
authors.initials: DL
authors.lastname: Conwell
authors.forename: Gregory
authors.initials: G
authors.lastname: Zuccaro
authors.forename: Frederick
authors.initials: F
authors.lastname: Van Lente
authors.forename: Edward
authors.initials: E
authors.lastname: Purich
authors.forename: Farah
authors.initials: F
authors.lastname: Khandwala
authors.forename: Seymour
authors.initials: S
authors.lastname: Fein
mesh_terms: D000328:Adult; D001639:Bicarbonates / Q000378:metabolism; D018592:Cross-Over Studies; D004384:Duodenoscopy / Q000379:methods*; D004386:Duodenum / Q000378:metabolism; D005260:Female; D005765:Gastrointestinal Agents; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007419:Intestinal Secretions / Q000737:chemistry; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000378:metabolism*; D010186:Pancreatic Function Tests; D012016:Reference Values; D012633:Secretin
chemical_list: D001639:Bicarbonates; D005765:Gastrointestinal Agents; D012633:Secretin