THE SONOGRAPHIC SECRETIN TEST IN PANCREATIC DISEASE‐HERE OR HISTORY?

Steven D. Pletcher, Glen Lehman

Research output: Contribution to journalReview article

Abstract

The pancreatic duct was studied prospectively with secretin‐stimulated ultrasonography in 59 patients with possible pancreatic disease and 20 healthy controls. Patients with acute pancreatitis, biliary obstruction, known pancreatic duct occlusion, or pancreatic duct >4 mm by sonography were excluded. Sonographic measurements were made at baseline and 2, 4, 6, and 10 min after a bolus injection of 1 CU/kg secretin (Sekretolin, Hoechst). The study was designed to assess the efficacy of sonographic secretin in diagnosing pancreatic disease (chronic pancreatitis or duct obstruction). The 20 control patients and 38 of 59 study patients in whom pancreatic disease was believed to he excluded had a mean pancreatic diameter of 1.5 ± 0.3 and 1.6 ± 0.5 mm, respectively. Mean maximal duct dilations was 2.9 ± 0.5 mm and 3.1 ± 0.5 mm (93% and 94% above baseline), respectively, and occurred between 2 and 6 min. By 10 min after injection, the duct dilation had decreased to 1.9 ± 0.4 mm. Twelve patients were found to have chronic pancreatitis diagnosed by ERP or CT scan, stool chymotrypsin, and periodically elevated amylase and lipase. Ten of them showed a mean pancreatic duct diameter of 2.6 ± 0.8 mm (range 1.5–3,5, p < 0.001 vs controls). Nine of 10 had minimal (0.5 mm) or no dilation after secretin injection (p < 0.001). One patient had dilation of 1.0 mm. Two other patients with chronic pancreatitis and one patient without chronic pancreatitis were found to have circumscript pancreatic duct stenosis. These showed basal duct diameters of 1.5 mm and dilated to 3.5–4.0 mm, 154% over baseline between 4 and 6 min. Dilation of 87% over baseline persisted at 10 min. The authors summarize the data by stating that the normal range of secretin induced enlargement was between 1.0 and 2.5 mm with <1 mm dilation persisting at 10 min. By these criteria, chronic pancreatitis was diagnosed in 11 of 12 patients, providing a sensitivity of 92%. In three of 59 patients without chronic pancreatitis, the test was falsely positive (one pancreatic divisum, one incomplete pancreatic divisum, and one history of acute pancreatitis), giving a 95% specificity.

Original languageEnglish (US)
Pages (from-to)1041-1042
Number of pages2
JournalThe American journal of gastroenterology
Volume85
Issue number8
DOIs
StatePublished - Aug 1990

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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