Original article
Clinical endoscopy
A prospective crossover study comparing secretin-stimulated endoscopic and Dreiling tube pancreatic function testing in patients evaluated for chronic pancreatitis

https://doi.org/10.1016/j.gie.2007.07.028Get rights and content

Background

Direct pancreatic function tests (PFT) are conventionally performed with use of double-lumen “Dreiling” collection tubes. We have developed an endoscopic collection method (ePFT) that eases the performance of these tests.

Objective

Our aim was to compare the bicarbonate results obtained from the secretin ePFT and Dreiling PFT methods in patients evaluated for chronic pancreatitis.

Design

A prospective crossover design was used to compare the PFT methods.

Setting

Tertiary care referral center.

Patients and Interventions

Twenty-four patients undergoing an evaluation for chronic pancreatitis underwent the secretin-stimulated ePFT and Dreiling PFT methods on separate days.

Main Outcome Measurements

Duodenal fluid bicarbonate concentrations and estimated bicarbonate outputs were compared.

Results

The mean difference in peak bicarbonate concentration (Dreiling PFT minus ePFT) was 7 mEq/L (SD 20) and not statistically significant (P = .11). A good correlation in peak bicarbonate concentrations (r = 0.74, 95% CI, 0.48-0.88) and estimated bicarbonate output (r = 0.78, 95% CI, 0.54-0.90) was observed between the two PFT methods.

Limitation

The sensitivities and specificities of the secretin ePFT and Dreiling PFT could not be compared because of the lack of a histologic gold standard.

Conclusion

The secretin ePFT yields results similar to those of the Dreiling PFT in patients evaluated for chronic pancreatitis.

Section snippets

Study population

The institutional review board at the Cleveland Clinic approved this research protocol. Patients with pancreatic-type abdominal pain13 with suspected or established chronic pancreatitis who were capable of informed consent were prospectively recruited. A focused medical history and physical examination was obtained from every subject. Female subjects of childbearing potential underwent a urine pregnancy test before each study procedure. All patients had recent cross-sectional imaging (CT/MRCP)

Demographic characteristics

Twenty-eight patients evaluated for chronic pancreatitis were recruited between January 2003 and December 2005 (Table 1). Four patients would not tolerate placement of the Dreiling tube, leaving 24 patients for analysis. Three patients had to repeat the Dreiling PFT because gastric fluid contamination was suspected on the basis of very low bicarbonate concentrations in all samples (<10 mEq/L). None of the ePFT tests had to be repeated for suspected gastric fluid contamination.

Bicarbonate results

In traditional

Discussion

We have shown that the endoscopic and Dreiling methods for secretin PFT produce similar bicarbonate results in patients evaluated for chronic pancreatitis. No significant differences were found between the two methods in either peak bicarbonate concentration or estimated bicarbonate output. These results suggest that the 1-hour endoscopic collection of secretin-stimulated duodenal fluid accurately measures exocrine function in the evaluation of patients with pancreatic-type abdominal pain.

After

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