Background and Aims

EUS and endoscopic pancreatic function tests (ePFTs) may be used to diagnose minimal-change chronic pancreatitis (MCCP). The impact of evaluation for exocrine pancreatic insufficiency (EPI) and real-time assessment of EUS changes after intravenous secretin on the clinical diagnosis of MCCP is unknown.

Methods

Patients with suspected MCCP underwent baseline EUS assessment of the pancreatic parenchyma and measurement of the main pancreatic duct (B-MPD) in the head, body, and tail. Human secretin 0.2 μg/kg was given intravenously followed 4, 8, and 12 minutes later by repeat MPD (S-MPD) measurements. Duodenal samples at 15, 30, and 45 minutes were aspirated to assess bicarbonate concentration. Endoscopists rated the percentage clinical likelihood of chronic pancreatitis (1) before secretin; (2) after secretin but before aspiration; and (3) after bicarbonate results.

Results

A total of 145 consecutive patients (mean age, 44±13 years; 98 females) were diagnosed with EPI (n = 32; 22%) or normal exocrine pancreatic function (n = 131, 78%). S-MPD/B-MPD ratios in the tail 4 and 8 minutes after secretin were higher in the group with normal exocrine function. Ratios at other times, locations, and duodenal fluid volumes were similar between the 2 groups. A statistically significant change in the median percentage likelihood of chronic pancreatitis was noted after secretin in all groups. The sensitivity and specificity of EPI for the EUS diagnosis of chronic pancreatitis (≥5 criteria) were 23.4% (95% confidence interval, 12.3-38.0) and 78.6% (95% confidence interval, 69.1-86.2), respectively.

Conclusion

Real-time EUS findings and ePFTs have a significant impact on the clinical assessment of MCCP. The diagnosis of EPI shows poor correlation with the EUS diagnosis of MCCP. (Clinical trial registration number: NCT01997476.)

中文翻译：

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EUS 胰腺功能检测和动态胰管评估用于诊断胰腺外分泌功能不全和慢性胰腺炎。

背景和目标

EUS 和内窥镜胰腺功能测试 (ePFT) 可用于诊断微小变化慢性胰腺炎 (MCCP)。评估胰腺外分泌功能不全（EPI）和实时评估静脉促胰液素后EUS变化对MCCP临床诊断的影响尚不清楚。

方法

疑似 MCCP 的患者接受了胰腺实质的基线 EUS 评估和头部、身体和尾部的主胰管 (B-MPD) 测量。静脉内给予人促胰液素 0.2 μg/kg，然后在 4、8 和 12 分钟后重复 MPD (S-MPD) 测量。在 15、30 和 45 分钟时抽取十二指肠样本以评估碳酸氢盐浓度。内镜医师在分泌素之前评估慢性胰腺炎的临床可能性百分比（1）；(2) 在分泌素之后但在抽吸之前；(3) 碳酸氢盐结果后。

结果

共有 145 名连续患者（平均年龄 44±13 岁；98 名女性）被诊断为 EPI（n = 32；22%）或胰腺外分泌功能正常（n = 131, 78%）。分泌素后 4 分钟和 8 分钟尾部的 S-MPD/B-MPD 比率在外分泌功能正常的组中较高。其他时间、位置和十二指肠液量的比率在两组之间相似。在所有组的促胰液素后，注意到慢性胰腺炎的中位百分比可能性的统计学显着变化。EPI 对 EUS 诊断慢性胰腺炎（≥5 个标准）的敏感性和特异性分别为 23.4%（95% 置信区间，12.3-38.0）和 78.6%（95% 置信区间，69.1-86.2）。

结论

实时 EUS 发现和 ePFT 对 MCCP 的临床评估有重大影响。EPI的诊断与EUS诊断MCCP的相关性较差。（临床试验注册号：NCT01997476。）