An endoscopic pancreatic function test with synthetic porcine secretin for the evaluation of chronic abdominal pain and suspected chronic pancreatitis
An endoscopic pancreatic function test with synthetic porcine secretin for the evaluation of chronic abdominal pain and suspected chronic pancreatitis
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DOI：
10.1067/mge.2003.14
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发表时间：
2003-01-01
影响因子：
7.7
通讯作者：
O'Laughlin, C
中科院分区：
文献类型：
--
作者：
Conwell, DL;Zuccaro, G;O'Laughlin, C
背景。对于无明显影像学改变的慢性胰腺炎患者，胰腺功能检查是诊断或排除慢性胰腺炎最可靠的方法，但检查繁琐、耗时、临床应用不广泛。合成的猪分泌素是一种27个氨基酸的肽，与生物形式相同，可用于外分泌功能测试。本研究考察了一种简单的，新开发的，纯内窥镜胰腺功能测试与合成猪分泌素的效用。方法：对伴有和不伴有慢性胰腺炎危险因素的慢性腹痛患者和晚期慢性胰腺炎患者进行研究。所有腹痛患者均为“胰腺型”疼痛，持续时间超过6个月，影像学检查均为阴性。所有慢性胰腺炎患者的胰腺造影和/或CT显示均为晚期疾病。参与者接受了以下方案：(1)在清醒镇静状态下对十二指肠下行进行标准内窥镜检查；(2)静脉给药分泌素（0.2马克杯/千克）；(3)分泌素注射后0、15、30、45、60分钟内镜下十二指肠液采集；(4)碳酸氢盐浓度流体分析。结果：18例患者（无危险因素腹痛5例，无危险因素腹痛7例）。有危险因素，6例为晚期慢性胰腺炎)。各组碳酸氢盐浓度中位数峰值（四分位数范围）分别为87（6，范围84-108）、72（10，范围68-90）和35（27，范围18-88）。三组的碳酸氢盐中位峰浓度值差异有统计学意义（p = 0.010； Kruskal-Wallis检验）。慢性胰腺炎患者与无危险因素腹痛患者相比，碳酸氢盐分泌明显减少（p = 0.038； Fisher精确检验）。伴有危险因素的腹痛患者的分泌功能曲线明显异常，类似于慢性胰腺炎患者的减弱分泌曲线。该试验是安全且耐受性良好的。结论：一个简单的内镜胰功能试验合成猪分泌素似乎可以区分已知的慢性胰腺炎患者和慢性腹痛的非慢性胰腺炎患者。这种简单实用的内窥镜检查可以在上内镜检查期间进行，并且可以减少对腹痛和正常放射成像研究患者的侵入性手术的需要。
Background. Pancreatic function tests are the most reliable methods for the diagnosis or exclusion of chronic pancreatitis in patients without obvious radiologic changes, but they are cumbersome, time consuming, and unavailable in clinical practice. Synthetic porcine secretin, a 27 amino acid peptide identical to the biologic form, is available for exocrine function testing. This study examined the utility of a simple, newly developed, purely endoscopic pancreatic function test with synthetic porcine secretin.Methods: Three groups of patients were studied: patients with chronic abdominal pain with and without risk factors for chronic pancreatitis, and patients with advanced chronic pancreatitis. All patients with abdominal pain had "pancreatic type" pain for greater than 6 months and negative radiographic imaging studies. All patients with chronic pancreatitis had advanced disease based on retrograde pancreatography and/or CT findings. Participants underwent the following protocol: (1) standard endoscopy to the descending duodenum with the patient under conscious sedation; (2) intravenous administration of secretin (0.2 mug/kg); (3) endoscopic duodenal fluid collection at 0, 15,30,45, and 60 minutes after secretin injection; and (4) fluid analysis for bicarbonate concentration.Results: Eighteen patients were studied (5 abdominal pain without risk factors, 7 abdominal pain. with risk factors, and 6 advanced chronic pancreatitis). Median peak (interquartile range) bicarbonate concentrations in meq/L for each group were, respectively, 87 (6, range 84-108), 72 (10, range 68-90), and 35 (27, range 18-88). Median peak bicarbonate concentration values for the 3 groups are significantly different (p = 0.010; Kruskal-Wallis test). Bicarbonate secretion in patients with chronic pancreatitis was markedly reduced compared with that in patients with abdominal pain without risk factors (p = 0.038; the Fisher exact test). The secretory function curve for patients with abdominal pain with risk factors was markedly abnormal, resembling the attenuated secretory curve seen in patients with chronic pancreatitis. The test was safe and well tolerated.Conclusions: A simple endoscopic pancreatic function test with synthetic porcine secretin appears to distinguish patients with known chronic pancreatitis from those with chronic abdominal pain without chronic pancreatitis. This simple, practical endoscopic test can be performed during upper endoscopy and may decrease the need for invasive procedures in patients with abdominal pain and normal radiographic imaging studies.