Quantification of pancreatic function using a clinically feasible short endoscopic secretin test.
OBJECTIVE
Clinical and morphological criteria are not precise enough to diagnose early chronic pancreatitis (CP). We investigated if short endoscopic pancreas function testing as a part of routine upper endoscopy could improve clinical diagnostics.


METHODS
Patients with suspected CP underwent modified secretin-stimulated upper endoscopy (short endoscopic secretin test, or EST). Duodenal juice was collected during 15 minutes starting 30 minutes after stimulation. A modified scoring system for CP after Layer with bicarbonate and fecal elastase 1 (FE1) was used. We tested with receiver operating characteristic curves the diagnostic accuracy of bicarbonate and FE1 and with analysis of variance how precise the 2 parameters can discriminate the groups.


RESULTS
Fifty-two patients aged 19 to 67 years and 25 healthy controls aged 19 to 64 years were included. Twenty-four patients fulfilled the modified Layer Score for CP or non-CP. The overall accuracy of the EST versus FE1 test was 85%/71%, with positive and negative predictive values of 100%/79% and 80%/69%, respectively.


CONCLUSIONS
Short EST is rapid and easy to perform and can be incorporated in daily routines. We demonstrate that EST is superior to FE1 in the assessment of pancreatic insufficiency and may prove to be useful in diagnosing early or mild CP.
From the *Medical Department, Voss Hospital, Haukeland University Hospital, Voss; †Institute of Medicine, University of Bergen; ‡Department of Medicine, §National Center for Ultrasound in Gastroenterology, and ∥Pediatric Department, Haukeland University Hospital; ¶Institute for Clinical Medicine, University of Bergen; and #Surgical Department, Haukeland University Hospital, Bergen, Norway.
Friedemann
F
Erchinger
Trond
T
Engjom
Erling
E
Tjora
Dag
D
Hoem
Trygve
T
Hausken
Odd Helge
OH
Gilja
Georg
G
Dimcevski
D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000032:analysis; D016022:Case-Control Studies; D016145:Endoscopy, Digestive System; D005243:Feces / Q000201:enzymology; D005260:Female; D006801:Humans; D007419:Intestinal Secretions / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D010196:Pancreatic Elastase / Q000032:analysis; D010186:Pancreatic Function Tests / Q000379:methods* / Q000706:statistics & numerical data; D050500:Pancreatitis, Chronic / Q000175:diagnosis*; D012633:Secretin; D013997:Time Factors; D055815:Young Adult
D001639:Bicarbonates; D012633:Secretin; D010196:Pancreatic Elastase