Simultaneous Combined Pancreatic Test

Abstract

SummaryA simultaneous combined pancreatic test can be performed in one morning with only one intubation of the duodenum. The test includes the measurement of exocrine pancreatic secretion of bicarbonate, enzymes, and radioactive selenium, pancreatic scanning, hypotonic duodenography, and cytology of the duodenal aspirate. In the first 70 patients it was found that a single secretion test was of only limited value in detecting pancreatic disease; cytology was the most reliable and scanning the least reliable single test; and that the combined test provided near-complete discrimination between patients with no pancreatic disease, with chronic pancreatitis, and with carcinoma of the pancreas.

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

“…10-13 Measurement of mannitol concentration in the duodenal fluid adjusts for distal losses and produces a more accurate estimation of total volume. An accurate volume measurement allows calculation of the total enzyme output, the gold standard for acinar secretory capacity.…”

Tests of Exocrine Pancreatic Function

“…Youngs and colleagues (1971) administered 75Se_ selenomethionine with the Lundh meal and counted 75Se-labelled enzymes in the 90-120 min sample. Though no more discriminating than the conventional Lundh test, this has the advantage of simplicity; the samples are stable and the test can be combined with pancreatic scanning as in section 2.7.1 (Nundy et al, 1974;Youngs et al, 1973). A smaller dose of isotope can be used if scanning is not performed but even then the slight radiation hazard probably precludes the collection of data on a large series of normals.…”

“…The addition of cytological examinations to the range of investigations improves the detection rate in cases of carcinoma of the pancreas, bile ducts or ampulla (Bourke et al, 1972;Nundy et al, 1974). The use of several tests simultaneously increases the diagnostic accuracy beyond that achieved by any single test but overlap with normals still occurs and the combined tests are unhelpful in the detection of supra-ampullary bile duct obstruction (Bourke et al, 1972;Nundy et al, 1974;Youngs et al, 1973). The examination of duodenal contents for bilirubin (Burton et al, 1960c) and radiological methods for outlining the biliary tree are capable of giving better results in these cases.…”

“…Positive findings in proven cases in various series have varied from 36 to 97% but the tumour site cannot be identified with certainty. The combination of secretin with CCK-PZ gives better results than secretin alone (Butler 1972;Nundy et al, 1974). The fibreoptic duodenoscopeallowscollection of aspirate from the duodenal wall, ampulla, or pancreatic duct itself and this results in a high detection rate, especially for carcinoma of the pancreatic head (Endo et al, 1974).…”

“…In cases of surgical jaundice, however, the intubation method (Burton et al, 1960a) gives greater accuracy than hypotonic duodenography (Bourke et al, 1972). The addition of cytological examinations to the range of investigations improves the detection rate in cases of carcinoma of the pancreas, bile ducts or ampulla (Bourke et al, 1972;Nundy et al, 1974). The use of several tests simultaneously increases the diagnostic accuracy beyond that achieved by any single test but overlap with normals still occurs and the combined tests are unhelpful in the detection of supra-ampullary bile duct obstruction (Bourke et al, 1972;Nundy et al, 1974;Youngs et al, 1973).…”