Rapid endoscopic secretin stimulation test and discrimination of chronic pancreatitis and pancreatic cancer from disease controls

Endoscopic Ultrasound and IL-8 in Pancreatic Juice to Diagnose Chronic Pancreatitis

“…Though there is no ideal gold standard beside histology, it is generally accepted that CP can be accurately established by demonstration of morphological changes and/ or impaired exocrine function [1][2][3][4][5][6][7] . ERCP remains the major modality for detection of morphological changes, while pancreatic exocrine function tests using intravenous hormones (secretin and/or cholecystokinin) infusion and analysis of duodenal drainage for enzymes and/ or bicarbonate are considered the gold standard modality for detection of impaired exocrine function [1][2][3][4][5][6][7] .…”

“…Chronic pancreatitis (CP) is a well-defined disease based on histopathology [1][2][3][4][5] . However, histology is not generally utilized for establishing the diagnosis in clinical practice because of a limited ability to obtain a tissue sample due to a deep-seated retroperitoneal location of the pancreas and the invasiveness of the core tissue biopsy [1][2][3][4][5] .…”

“…However, histology is not generally utilized for establishing the diagnosis in clinical practice because of a limited ability to obtain a tissue sample due to a deep-seated retroperitoneal location of the pancreas and the invasiveness of the core tissue biopsy [1][2][3][4][5] . As a result, the diagnosis of CP is primarily made by typical signs and/or symptoms compatible with CP and confirmed with alternative diagnostic tests, in particular pancreatic exocrine function tests with intravenous cholecystokinin or secretin stimulation and endoscopic retrograde cholangiopancreatography (ERCP) [1][2][3][4][5][6][7] . However, these tests are less than perfect.…”

“…Pancreatic exocrine function tests are only available at the limited number of tertiary care referral centers. In addition, it is cumbersome to perform and uncomfortable for patients because of the need of prolonged duodenal intubation for fluid collection [1][2][3][4][5] . ERCP thereby has remained the gold standard modality to diagnose CP.…”

“…ERCP thereby has remained the gold standard modality to diagnose CP. Several studies have indicated that ERCP may be insensitive in detecting subtle morphological changes of the pancreatic parenchyma with reported sensitivity of 95% and only 60-70% in patients with advanced and early disease, respectively [1][2][3][4][5][6][7][8] . Furthermore, purely diagnostic ERCP is rarely performed due to the risk of significant acute pancreatitis.…”