The endoscopic pancreatic function test-time to take a step back.

摘要

The diagnosis of chronic pancreatitis can be remarkably easy or a very difficult clinical challenge. No additional tests are needed for a patient with a compatible history and extensive calcifications throughout the pancreas on standard abdominal radiograph. However, the diagnosis may be extremely difficult to establish or exclude for a patient with abdominal pain and normal or equivocal findings on abdominal imaging. It is in this latter setting that the direct measurement of pancreatic exocrine function has become a sort of reference standard, given the inability to routinely assess pancreatic histology. Direct tests of pancreatic function have typically involved fluoroscopic placement of an oroduodenal tube and measurement in duodenal fluid of either pancreatic enzymes (eg, trypsin, lipase) after maximal pharmacologic stimulation of the pancreas with cholecystokinin (CCK) or bicarbonate after maximal stimulation with secretin. The use of these tests has been greatly limited by their lack of standardization; furthermore, these tests are unpleasant for the patient and cumbersome and time consuming to perform.