title: Diagnostic accuracy of secretin-stimulated ultrasonography of the pancreas assessing exocrine pancreatic failure in cystic fibrosis and chronic pancreatitis.
abstract: OBJECTIVE
  Volume output failure is a feature of decreasing exocrine pancreatic function. This parameter is assessed by secretin-stimulated MRI in several studies. Our purpose was to evaluate ultrasonography of the fluid in the descending duodenum and Wirsung duct (WD) after secretin stimulation as a measure of pancreatic fluid flow in patients expected to have severe output failure.
  
  
  METHODS
  We included subjects with chronic pancreatitis (CP), cystic fibrosis (CF) and a group of healthy controls in a prospective observation study. Transabdominal ultrasonography was performed before and during 15 min after secretin i.v. duodenal juice was collected by endoscopic short test (EST), and bicarbonate concentration measured. Patient groups were classified according to exocrine pancreatic function.
  
  
  RESULTS
  Pancreatic insufficient CF (CFI) patients and CP insufficient (CPI) patients showed less duodenal fluid filling compared to other groups (p < 0.001). Measures of the WD diameter could only identify the most severe failure in the CFI group (p < 0.001).
  
  
  CONCLUSIONS
  Secretin-stimulated ultrasonography can be used to assess pancreatic fluid flow and may be combined with EST in the evaluation of exocrine pancreatic function. Fluid filling in the descending part of duodenum was the most accurate predictor of pancreatic insufficiency in both patient groups. The test demonstrated better diagnostic accuracy diagnosing exocrine pancreatic failure in the CF patients than in CP patients.
authors.affiliation: Department of Medicine, Haukeland University Hospital, Haukeland University Hospital , 5021 Bergen , Norway.
authors.forename: Trond
authors.initials: T
authors.lastname: Engjom
authors.forename: Friedemann
authors.initials: F
authors.lastname: Erchinger
authors.forename: Erling
authors.initials: E
authors.lastname: Tjora
authors.forename: Birger N
authors.initials: BN
authors.lastname: Lærum
authors.forename: Dimcevski
authors.initials: D
authors.lastname: Georg
authors.forename: Odd H
authors.initials: OH
authors.lastname: Gilja
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000737:chemistry; D016022:Case-Control Studies; D003550:Cystic Fibrosis / Q000000981:diagnostic imaging*; D004386:Duodenum / Q000000981:diagnostic imaging; D010188:Exocrine Pancreatic Insufficiency / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging; D010189:Pancreatic Juice / Q000000981:diagnostic imaging*; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012633:Secretin / Q000008:administration & dosage*; D012720:Severity of Illness Index; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D001639:Bicarbonates; D012633:Secretin
keywords: chronic pancreatitis; cystic fibrosis; exocrine pancreatic function; gastrointestinal ultrasonography