Physiological evaluation of the severity of pancreatic exocrine dysfunction during endoscopy.
OBJECTIVE
Despite the advances in pancreatic imaging, there continues to be a need to measure exocrine function to determine which patient requires enzyme supplementation. To evaluate the potential use of a rapid endoscopic test that can be conducted by nonacademic centers, we investigated whether concentration of trypsin in food-stimulated secretion is related to trypsin synthesis and secretion.


METHODS
Subjects include 22 chronic pancreatitis patients (10 mild, 5 moderate, and 7 severe radiological disease) and 11 healthy controls. During upper gastrointestinal endoscopy, pancreatic secretion was stimulated by a single 30-mL duodenal injection of an enteral diet, followed 5 minutes later by periampullary juice aspiration (endoscopic pancreatic function test [ePFT]). This was followed by a conventional 2-hour marker-perfusion diet-stimulated pancreatic trypsin secretion and synthesis study (2-hour PFT [2hPFT]).


RESULTS
Severity of radiological disease was associated with a progressive loss of enzyme secretion measured by the 2hPFT. The endoscopic PFT correlated positively with 2hPFT (r2 = 0.48; P < 0.0001) and an activity of less than 5% of the average normal had a 96% specificity and 75% sensitivity for the detection of pancreatic insufficiency as defined by a loss of greater than 90% of pancreatic secretion.


CONCLUSIONS
The diagnostic power of endoscopy may be enhanced by the collection of a pancreatic juice sample after enteral feed stimulation because measurement of the trypsin content will identify chronic pancreatitis patients who will be benefited by enzyme supplementation.
O'Keefe
Stephen J D
SJ
Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA 15213, USA. sjokeefe@pitt.edu
Stevens
Stacie
S
Lee
Ronzo
R
Zhou
Wen
W
Zfass
Alvin
A
D000328:Adult; D000681:Amylases / Q000378:metabolism; D001944:Breath Tests; D002250:Carbon Radioisotopes; D004041:Dietary Fats / Q000493:pharmacokinetics; D004435:Eating; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D008049:Lipase / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D046790:Pancreas, Exocrine / Q000201:enzymology / Q000473:pathology* / Q000503:physiopathology*; D010189:Pancreatic Juice / Q000201:enzymology / Q000378:metabolism; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014304:Triolein / Q000493:pharmacokinetics; D014357:Trypsin / Q000378:metabolism
D002250:Carbon Radioisotopes; D004041:Dietary Fats; D014304:Triolein; D008049:Lipase; D000681:Amylases; D014357:Trypsin