title: Endoscopic pancreatic function test using combined secretin and cholecystokinin stimulation for the evaluation of chronic pancreatitis.
abstract: BACKGROUND
  Current endoscopic pancreatic function test (ePFT) methods use either secretin or cholecystokinin (CCK) to measure pancreatic function.
  
  
  OBJECTIVE
  To evaluate a novel ePFT protocol that includes both secretin and CCK stimulation and to assess which fluid parameters best discriminate patients with chronic pancreatitis (CP).
  
  
  METHODS
  Prospective, cross-sectional diagnostic study.
  
  
  METHODS
  Single, tertiary-care institution.
  
  
  METHODS
  Healthy volunteers and patients evaluated for CP were included.
  
  
  METHODS
  All patients underwent a combined secretin-CCK ePFT. Patients evaluated for CP also underwent EUS during the same endoscopic session.
  
  
  METHODS
  Duodenal fluid bicarbonate, lipase, and amylase concentrations were measured after CCK and secretin stimulation. Results were compared based on the presence of CP detected by EUS (≥5 features).
  
  
  RESULTS
  Twenty healthy volunteers and 69 patients evaluated for CP completed the secretin and CCK ePFT. Patients with an EUS score of 5 or higher had significantly decreased peak bicarbonate concentrations (72 mmol) compared with patients with an EUS score lower than 5 (90 mmol) and healthy subjects (108 mmol) (P < .001). Peak concentrations of amylase and lipase and total fluid volume were not significantly different between patients with CP and controls. Receiver-operating characteristic analysis revealed that peak bicarbonate concentration had superior discrimination for CP (area under the curve [AUC] 0.738) compared with peak amylase (AUC 0.677) and peak lipase (AUC 0.627). The addition of enzyme concentration measurement did not improve discrimination compared with peak bicarbonate alone.
  
  
  CONCLUSIONS
  Secretin and cholecystokinin endoscopic pancreatic function test (SC ePFT) results were not compared with those of single hormone ePFTs.
  
  
  CONCLUSIONS
  The addition of CCK infusion and enzyme concentration measurement to a standard secretin ePFT does not enhance the diagnosis of CP.
authors.affiliation: Medicine Institute, The Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Law
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Adele
authors.initials: A
authors.lastname: Costanzo
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Parsi
authors.forename: Tyler
authors.initials: T
authors.lastname: Stevens
mesh_terms: D061354:Acinar Cells / Q000187:drug effects / Q000201:enzymology; D000328:Adult; D000681:Amylases / Q000187:drug effects / Q000378:metabolism; D019540:Area Under Curve; D001639:Bicarbonates / Q000378:metabolism; D016009:Chi-Square Distribution; D002766:Cholecystokinin; D003430:Cross-Sectional Studies; D004384:Duodenoscopy; D004386:Duodenum / Q000378:metabolism; D019160:Endosonography; D005260:Female; D006801:Humans; D008049:Lipase / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010186:Pancreatic Function Tests / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D012372:ROC Curve; D012633:Secretin; D018709:Statistics, Nonparametric
chemical_list: D001639:Bicarbonates; D012633:Secretin; D002766:Cholecystokinin; D008049:Lipase; D000681:Amylases