Endoscopic pancreatic function test using combined secretin and cholecystokinin stimulation for the evaluation of chronic pancreatitis

Abstract

Background Current endoscopic pancreatic function test (ePFT) methods use either secretin or cholecystokinin (CCK) to measure pancreatic function. Objective Evaluate a novel ePFT protocol that includes both secretin and CCK stimulation, and assess which fluid parameters best discriminate patients with chronic pancreatitis (CP). Design Prospective, cross-sectional diagnostic study. Setting Single, tertiary-care institution. Patients and interventions Healthy volunteers and patients evaluated for CP were included. All patients underwent a combined secretin-CCK ePFT. Patients evaluated for CP also underwent EUS during the same endoscopic session. Main outcome measurements Duodenal fluid bicarbonate, lipase, and amylase concentrations were measured after CCK and secretin stimulation. Results were compared based on the presence of CP detected by EUS (≥5 features) Results Twenty healthy volunteers and 69 patients evaluated for CP completed the SC ePFT. Patients with EUS score ≥5 had significantly decreased peak bicarbonate concentrations (72 mM) compared with patients with EUS score <5 (90 mM) and healthy subjects (108 mM) (p<0.001). Peak concentrations of amylase and lipase and total fluid volume were not significantly different between patients with CP and controls. ROC analysis revealed that peak bicarbonate concentration had superior discrimination for CP (AUC=0.738) compared with peak amylase (AUC 0.677) and peak lipase (AUC 0.627). The addition of enzyme concentration measurement did not improve discrimination compared with peak bicarbonate alone. Limitations SC ePFT results were not compared with single hormone ePFTs. Conclusions The addition of CCK infusion and enzyme concentration measurement to a standard secretin ePFT does not enhance the diagnosis of CP.

Chronic Pancreatitis and Nutrition Therapy

“…There is significant variability and error with this test, and it has largely been replaced. The secretin‐cholecystokinin (CCK) stimulation test is a direct measure of pancreatic function and is the current gold standard for diagnosis . The secretin‐CCK test is a combination of 2 tests—the secretin test, which measures pancreatic ductal cell bicarbonate and fluid secretion, and the CCK test, which measures pancreatic acinar cell enzyme secretion.…”

Diagnosis of Exocrine Pancreatic Insufficiency

“…Several variations of direct PFTs using endoscopy have been described including the use of secretin and/ or CCK [10][11][12][13][14][15]. Rather than using an enteric tube, duodenal lumen contents are aspirated through the accessory channel of the endoscope.…”

Endoscopic Pancreas Fluid Collection: Methods and Relevance for Clinical Care and Translational Science

“…Even though this measurement is more directly a measure of pancreatic duct epithelial cell function than acinar cell function, previous studies have demonstrated a correlation between the peak bicarbonate and lipase concentrations in pancreatic fluid (3). For the evaluation of CP, measurement of peak bicarbonate concentration (following secretin stimulation) has improved discrimination compared with peak lipase or amylase concentrations following cholecystokinin stimulation (4). Notably, a retrospective follow-up study demonstrated that the negative predictive value of a normal bicarbonate response to secretin stimulation to rule out CP is high (97%), while the positive predictive value (45%) is poor (5).…”

“…However, it is necessary to utilize standardized methodology for PF collection to ensure that downstream analyses are accurate and reproducible. We set out to: (1) review the clinical role of ePFT, (2) discuss the current methodology for endoscopic PF collection, (3) review preliminary observations demonstrating opportunities for future translational research, and (4) to identify gaps in knowledge.…”