Electrolyte composition of endoscopically collected duodenal drainage fluid after synthetic porcine secretin stimulation in healthy subjects

Stevens, Tyler; Conwell, Darwin L.; Zuccaro, Gregory; Lente, Frederick Van; Khandwala, Farah; Purich, Edward D.; Vargo, John J.; Fein, Seymour; Dumot, John A.; Trolli, Pat; OLAUGHLIN, C

doi:10.1016/s0016-5107(04)01809-7

Cited by 49 publications

(33 citation statements)

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“…The highest bicarbonate concentration from the timed samples is considered the peak bicarbonate. Normal mean value: 108 mEq/l (SD 13 mEq/l); peak bicarbonate <80 mEq/l is considered abnormal and suggestive of exocrine insufficiency [13]. Pancreas insufficiency was further categorized based on peak bicarbonate values according to the following criteria: mild (70–79 mEq/l), moderate (60–69 mEq/l), and severe (<60 mEq/l) pancreas exocrine insufficiency.…”

Section: Methodsmentioning

confidence: 99%

Magnetic Resonance Cholangiopancreatography Reports in the Evaluation of Chronic Pancreatitis: A Need for Quality Improvement

Zuccaro¹,

Stevens

Repas

et al. 2009

Pancreatology

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Section: Methodsmentioning

confidence: 99%

Magnetic Resonance Cholangiopancreatography Reports in the Evaluation of Chronic Pancreatitis: A Need for Quality Improvement

Zuccaro¹,

Stevens

Repas

et al. 2009

Pancreatology

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“…The overall accuracy of the endoscopic secretin test was 79% with positive and negative predictive values of 73% and 85%, respectively [40]. Stevens and co-workers showed that duodenal fluid collected endoscopically after secretin stimulation revealed the same anion-cation secretory curve as that found during standard ''tube tests'' [41,42]. However, this collection requires endoscopies lasting for at least 30 minutes and therefore confers a significant burden for the endoscopist and patient.…”

Section: Direct Pancreatic Function Testsmentioning

confidence: 99%

Diagnostic workup of patients with pancreatic diseases

et al. 2009

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Zusammenfassung. Grundlagen: Zu den Erkrankungen der Bauchspeicheldrüse gehören eine große Zahl unterschiedlicher Krankheitsbilder, die von angeborenen Fehlbildungen über entzündliche Erkrankungen wie der akuten und chronischen Pankreatitis, über Neoplasien epithelialen, mesenchymalen und neuroendokrinen Ursprungs, bis zu erblichen Erkrankungen, die mit Keimbahnmutationen einhergehen und bis zur Autoimmunpankreatitis reichen.Methodik: Im folgenden Artikel werden nicht nur die Stärken und Schwächen der am häufigsten verwendeten Laboruntersuchungen und bildgebenden Verfahren dargestellt, zu denen der endoskopische Ultraschall, die Computertomographie und die Kernspintomographie gehören, sondern auch die Indikationen für genetische Untersuchungen und Funktionstests. Seltene Erkrankungen, die häufig eine Herausforderung für die Differentialdiagnose darstellen und erbliche Prädispositionen für die Pankreatitis und das Pankreaskarzinom werden ebenfalls diskutiert.Ergebnisse und Schlussfolgerungen: Das Spektrum der diagnostischen Verfahren, die in der Klinik für die Differentialdiagnose bei Patienten mit Pankreaserkrankungen eingesetzt und auch bei deren Verwandten mit hohem Erkrankungsrisiko verwendet werden, ist deshalb außerordentlich breit. Es reicht von einfachen klinischchemischen Untersuchungen über Funktionsuntersuchungen für die endokrine und exokrine Pankreasinsuffizienz bis zu bildgebenden Verfahren und Gentests.Schlüsselwörter: Akute Pankreatitis, chronische Pankreatitis, Funktionstests, genetische Testung, Pankreaskarzinom.Summary. Background: Pancreatic disorders comprise a large number of entities that include congenital malformations, inflammatory disorders such as acute and chronic pancreatitis, neoplasias of epithelial, mesenchymal, and neuroendocrine origin, inherited disorders that are associated with germline mutations and autoimmune pancreatitis.Methods: The following article will not only review the strength and weaknesses of the most commonly used laboratory tests and imaging modalities such as endoscopic ultrasound, CT scanning, and MRI but also outline the indications for genetic studies and function tests. Rare disorders that often present as a challenging differential diagnosis and genetic predispositions for pancreatitis and pancreatic cancer will also be covered.Results and conclusions: The spectrum of diagnostic tests being used for the clinical work-up of patients with pancreatic disorders and at-risk relatives is accordingly broad. It ranges from simple clinical chemistry to function tests for endocrine and exocrine insufficiency, to imaging techniques and genetic testing.

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“…The pancreas function test is uncomfortable for the patient, expensive, and time-consuming. A shorter-duration endoscopic collection of the pancreatic secretions is an alternative but is less sensitive (7). These current pancreatic function tests are so cumbersome and insensitive that they are essentially obsolete and not being used by most practitioners.…”

mentioning

confidence: 99%

An Exocrine Pancreatic Stress Test with ¹¹C-Acetate PET and Secretin Stimulation

Lodge

Buscaglia

et al. 2014

J Nucl Med

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The purpose of this study was to develop a noninvasive imaging test of pancreatic exocrine function. Methods: In this pilot study, 5 healthy volunteers underwent two 60-min dynamic 11 C-acetate PET studies, one before and one after intravenous secretin administration. Kinetic analysis of the pancreas was performed using a 1-compartment model and an image-derived input function. From summed images, standardized uptake values were measured from the pancreas and the liver, and the pancreas-to-liver ratio was computed. Results: The baseline k 1 and k 2 data for all 5 volunteers were consistent. After secretin stimulation, the k 1 and k 2 significantly increased (paired t test P 5 0.046 and P 5 0.023, respectively). In the summed PET images, the pancreas-to-liver ratio decreased (P 5 0.037). Increased 11 C-acetate activity was observed in the duodenum after secretin stimulation consistent with secretin-induced secretion. Conclusion: 11 C-acetate PET studies with secretin stimulation show potential as a noninvasive method for assessing pancreatic exocrine function. Chr onic pancreatitis has a high prevalence in developed countries, 25-30 cases per 100,000 people, and an even higher prevalence of approximately 5% in autopsy studies (1,2). The transition from acute pancreatitis, which is the second most common gastrointestinal discharge diagnosis in the United States, to chronic pancreatitis is challenging to identify. Accurate diagnosis of early chronic pancreatitis is difficult with imaging studies such as CT, MR imaging, endoscopic retrograde cholangiopancreatography, or endoscopic ultrasound. Pancreatic volume loss is evident only in the late stages, taking 5-10 y or longer to develop (3). Although imaging and function tests at the early stages of the disease are often negative, early recognition is important to help with accurate diagnosis, reduce disease progression, and prevent unnecessary interventions (4).A pancreas function test is the most sensitive test described but is not readily performed at most centers (5). The pancreas function test involves passing a tube into the duodenum, injecting a supraphysiologic dose of secretin, and then collecting the pancreatic secretions over an hour to measure the bicarbonate concentration. Secretin is a hormone that stimulates the pancreatic ductal cells to excrete fluid and bicarbonate, and normally, the bicarbonate concentration will double after secretin stimulation in 15 min (6). The pancreas function test is uncomfortable for the patient, expensive, and time-consuming. A shorter-duration endoscopic collection of the pancreatic secretions is an alternative but is less sensitive (7). These current pancreatic function tests are so cumbersome and insensitive that they are essentially obsolete and not being used by most practitioners.11 C-acetate PET was developed first to study oxygen metabolism in the myocardium and is currently applied in oncology for prostate cancer, hepatocellular carcinoma, and brain tumors (8). Intense 11 C-acetate uptake is consistently noted in t...

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Electrolyte composition of endoscopically collected duodenal drainage fluid after synthetic porcine secretin stimulation in healthy subjects

Cited by 49 publications

References 15 publications

Magnetic Resonance Cholangiopancreatography Reports in the Evaluation of Chronic Pancreatitis: A Need for Quality Improvement

Magnetic Resonance Cholangiopancreatography Reports in the Evaluation of Chronic Pancreatitis: A Need for Quality Improvement

Diagnostic workup of patients with pancreatic diseases

An Exocrine Pancreatic Stress Test with ¹¹C-Acetate PET and Secretin Stimulation

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Electrolyte composition of endoscopically collected duodenal drainage fluid after synthetic porcine secretin stimulation in healthy subjects

Cited by 49 publications

References 15 publications

Magnetic Resonance Cholangiopancreatography Reports in the Evaluation of Chronic Pancreatitis: A Need for Quality Improvement

Magnetic Resonance Cholangiopancreatography Reports in the Evaluation of Chronic Pancreatitis: A Need for Quality Improvement

Diagnostic workup of patients with pancreatic diseases

An Exocrine Pancreatic Stress Test with 11C-Acetate PET and Secretin Stimulation

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Product

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An Exocrine Pancreatic Stress Test with ¹¹C-Acetate PET and Secretin Stimulation