Defining the Accuracy of Secretin Pancreatic Function Testing in Patients With Suspected Early Chronic Pancreatitis

Abstract

OBJECTIVES The diagnosis of chronic pancreatitis in patients with characteristic symptoms but normal pancreatic imaging is challenging. Assessment of pancreatic function through secretin pancreatic function testing (SPFT) has been advocated in this setting, but its diagnostic accuracy is not fully known. METHODS This was a retrospective review of patients who received SPFT at our tertiary care institution between January 1995 and December 2008 for suspected chronic pancreatitis. For all patients, medical records were reviewed for evidence of subsequent development of chronic pancreatitis by imaging and/or pathology. Patients were then categorized as “true positive” or “true negative” for chronic pancreatitis based on follow-up imaging or histologic evidence. RESULTS In all, 116 patients underwent SPFT. Of the 27 patients who tested positive, 7 were lost to follow-up. Of the remaining 20 SPFT-positive patients, 9 (45 %) developed radiologic or histologic evidence of chronic pancreatitis after a median of 4 years (1–11 years). Of the 89 patients who had negative SPFT testing, 19 were lost to follow-up. Of the remaining 70 patients, 2 were eventually diagnosed with chronic pancreatitis based on subsequent imaging/histology after a median follow-up period of 7 years (3–11 years). The sensitivity of the SPFT in diagnosing chronic pancreatitis was 82 % with a specificity of 86 %. The positive predictive value (PPV) of chronic pancreatitis was 45 % with a negative predictive value (NPV) of 97 %. CONCLUSIONS In patients with suspected early chronic pancreatitis and normal pancreatic imaging, SPFT is highly accurate at ruling out early chronic pancreatitis with a NPV of 97 %.

Potential for Screening for Pancreatic Exocrine Insufficiency Using the Fecal Elastase-1 Test

“…The development of multidetector computerized tomography (CT) has improved the accuracy of CT in diagnosing CP and pancreatic neoplasms; however, the improved accuracy is only in cases where there is focal enlargement of the pancreas, which occurs in approximately 30% of CP cases, and these disorders have several overlapping morphologic features that limit its application [39]. Indeed, diagnosing CP by imaging techniques can miss cases in which morphological changes are not very prominent [37]; however, declining pancreatic exocrine secretion may precede detectable morphological changes [40]. For many years, the gold-standard methods of examining pancreatic function have been the secretin-stimulation tests, which include the secretin-only, secretin-CCK, and secretin-cerulein tests.…”

“…Comparison of the FE-1 test with the direct pancreatic function tests, the secretin-CCK or secretin-cerulein tests[23,[39][40][41][42][43][44] Patients with clinical symptoms of malassimilation ULN for FE-1: 200 lg/g stool…”

Chronic pancreatitis: An international draft consensus proposal for a new mechanistic definition

“…Attempts to use pancreatic duct function as an early diagnostic tool for CP also faces challenges since multiple CFTR gene mutations result in defective bicarbonate conductance that is independent of inflammation or other pancreatic disease (43). The limitation of function testing was shown by Ketwaroo et al (32), who calculated that the positive predictive value of secretin-stimulated pancreatic function testing for early CP was only 45% while the negative predictive value was of 97%. Thus, the use of function testing to diagnose early CP defined by pathologic criteria is ineffective.…”

Managing Chronic Pancreatitis: The View from Medical Pancreatology

“…We are cognizant that a normal or minimally abnormal EUS does not exclude or diagnose CP, and the confounding effect of several factors (e.g., age, alcohol, tobacco, and diabetes) on parenchymal and ductal changes must also be considered [2, 3]. We do not routinely use secretinstimulated pancreatic function testing in clinical practice, as its positive predictive value is suboptimal [4], and may not affect decision making.…”