Physiological evaluation of the severity of pancreatic exocrine dysfunction during endoscopy.

Abstract

OBJECTIVES:

Despite the advances in pancreatic imaging, there continues to be a need to measure exocrine function to determine which patient requires enzyme supplementation. To evaluate the potential use of a rapid endoscopic test that can be conducted by nonacademic centers, we investigated whether concentration of trypsin in food-stimulated secretion is related to trypsin synthesis and secretion.

METHODS:

Subjects include 22 chronic pancreatitis patients (10 mild, 5 moderate, and 7 severe radiological disease) and 11 healthy controls. During upper gastrointestinal endoscopy, pancreatic secretion was stimulated by a single 30-mL duodenal injection of an enteral diet, followed 5 minutes later by periampullary juice aspiration (endoscopic pancreatic function test [ePFT]). This was followed by a conventional 2-hour marker-perfusion diet-stimulated pancreatic trypsin secretion and synthesis study (2-hour PFT [2hPFT]).

RESULTS:

Severity of radiological disease was associated with a progressive loss of enzyme secretion measured by the 2hPFT. The endoscopic PFT correlated positively with 2hPFT (r2 = 0.48; P < 0.0001) and an activity of less than 5% of the average normal had a 96% specificity and 75% sensitivity for the detection of pancreatic insufficiency as defined by a loss of greater than 90% of pancreatic secretion.

CONCLUSIONS:

The diagnostic power of endoscopy may be enhanced by the collection of a pancreatic juice sample after enteral feed stimulation because measurement of the trypsin content will identify chronic pancreatitis patients who will be benefited by enzyme supplementation.

• Authors: Stephen J D O'Keefe, Stacie Stevens, Ronzo Lee, Wen Zhou, Alvin Zfass
• Journal: Pancreas (Pancreas) Vol. 35 Issue 1 Pg. 30-6 (Jul 2007) ISSN: 1536-4828 [Electronic] United States
• PMID: 17575542 (Publication Type: Controlled Clinical Trial, Journal Article)

Chemical References

• Carbon Radioisotopes
• Dietary Fats
• Triolein
• Lipase
• Amylases
• Trypsin

Topics

• Adult
• Amylases (metabolism)
• Breath Tests
• Carbon Radioisotopes
• Dietary Fats (pharmacokinetics)
• Eating
• Endoscopy, Digestive System (methods)
• Female
• Humans
• Lipase (metabolism)
• Male
• Middle Aged
• Pancreas, Exocrine (enzymology, pathology, physiopathology)
• Pancreatic Juice (enzymology, metabolism)
• Pancreatitis, Chronic (diagnostic imaging, pathology, physiopathology)
• Radionuclide Imaging
• Sensitivity and Specificity
• Severity of Illness Index
• Triolein (pharmacokinetics)
• Trypsin (metabolism)