Diagnostic accuracy of secretin-stimulated ultrasonography of the pancreas assessing exocrine pancreatic failure in cystic fibrosis and chronic pancreatitis

Abstract

Objective. Volume output failure is a feature of decreasing exocrine pancreatic function. This parameter is assessed by secretin-stimulated MRI in several studies. Our purpose was to evaluate ultrasonography of the fluid in the descending duodenum and Wirsung duct (WD) after secretin stimulation as a measure of pancreatic fluid flow in patients expected to have severe output failure. Material and methods. We included subjects with chronic pancreatitis (CP), cystic fibrosis (CF) and a group of healthy controls in a prospective observation study. Transabdominal ultrasonography was performed before and during 15 min after secretin i.v. duodenal juice was collected by endoscopic short test (EST), and bicarbonate concentration measured. Patient groups were classified according to exocrine pancreatic function. Results. Pancreatic insufficient CF (CFI) patients and CP insufficient (CPI) patients showed less duodenal fluid filling compared to other groups (p < 0.001). Measures of the WD diameter could only identify the most severe failure in the CFI group (p < 0.001). Conclusion. Secretin-stimulated ultrasonography can be used to assess pancreatic fluid flow and may be combined with EST in the evaluation of exocrine pancreatic function. Fluid filling in the descending part of duodenum was the most accurate predictor of pancreatic insufficiency in both patient groups. The test demonstrated better diagnostic accuracy diagnosing exocrine pancreatic failure in the CF patients than in CP patients.

Key Words:

• chronic pancreatitis
• cystic fibrosis
• exocrine pancreatic function
• gastrointestinal ultrasonography

Acknowledgements

The study was supported by MedViz http://medviz.uib.no/, an interdisciplinary research cluster from Haukeland University Hospital, University of Bergen and Christian Michelsen Research AS. The Authors have received travelling grants and scholarships from Abbott, the Norwegian Gastroenterology association and Norwegian cystic fibrosis foundation. A special acknowledgement to supporting lab technicians Liv Aasmul and Aud Sissel Hjartholm for preserving and running analyses of duodenal juice and to Line Lærum for taking care of the cystic fibrosis patients during the inclusion.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.