Combined endoscopic ultrasound and secretin endoscopic pancreatic function test in patients evaluated for chronic pancreatitis

Abstract

Background: Endoscopic ultrasound and endoscopic secretin pancreatic function test may be combined in a single endoscopic session (EUS/ePFT) to diagnose chronic pancreatitis (CP). Aims: Our primary aim was to assess the correlation and concordance of combined EUS and secretin ePFT bicarbonate results in suspected minimal change CP. Methods: Radial EUS included scoring for nine criteria (normal <4 criteria) with endoscopic collection of duodenal samples at 15, 30, and 45 min after secretin stimulation (normal peak bicarbonate ≥80 mmol/l). Results: Three hundred and two patients completed the EUS/ePFT (252 for suspected minimal change CP, 38 for established CP, 12 for painless steatorrhea). In patients evaluated for suspected minimal change CP, a moderate negative correlation was observed between endoscopic ultrasound score and peak bicarbonate (r = -0.38, P < 0.001). The EUS and ePFT results were 76% concordant and 24% discordant. The ePFT was 85% sensitive and EUS was 100% sensitive for detecting patients with established calcific CP. The EUS/ePFT diagnosed CP in two of 12 of patients evaluated for painless steatorrhea or diarrhea with weight loss. Conclusions: The combined EUS/ePFT is feasible and safe. There is only moderate correlation and concordance of endoscopic ultrasound and endoscopic pancreatic function test results in patients with suspected minimal change CP. The EUS and ePFT results produce complimentary functional and structural information for the evaluation of CP. © 2010 Springer Science+Business Media, LLC.