Endoscopic Pancreas Fluid Collection: Methods and Relevance for Clinical Care and Translational Science

Abstract

Pancreatic secretions have an important role in the regulation of a normal nutritional state but can be altered owing to a variety of pathophysiological mechanisms in the context of exocrine pancreatic disease. The development of an endoscopic technique for collection of pancreatic fluid, termed endoscopic pancreatic function testing, has led to improved understanding of these alterations and is particularly helpful to characterize chronic pancreatitis. In addition, investigators have found endoscopically collected pancreatic fluid to be a valuable biofluid for the purposes of translational science. Techniques such as proteomic, cytokine, genetic mutation, DNA methylation, and microRNA analyses, among others, can be utilized to gain a better understanding of the molecular characteristics of chronic pancreatitis and other pancreatic diseases. Endoscopic collection of pancreatic fluid is safe and relatively straightforward, permitting opportunities for longitudinal analysis of these translational markers throughout the course of disease. This manuscript summarizes our current knowledge of pancreatic fluid, with an emphasis on proper techniques for sample collection and handling, its clinical utility, and preliminary observations in translational science.

Chronic Pancreatitis: Current Status and Challenges for Prevention and Treatment

“…There are currently no clinically validated and utilized markers of fibrosis and inflammation in pancreatic fluid although preliminary studies have demonstrated that this fluid can be used for a variety of measures related to inflammation and fibrosis [109]. In near future, it may be possible that studies of pancreatic fluid can lead to biomarkers of inflammation and fibrosis that characterize subsets of patients and response to specific therapeutic interventions.…”

Diagnosing Chronic Pancreatitis

“…Of those with positive sPFTs, 9 later developed CP where as of the 70 with negative sPFTs, only 2 patients later developed chronic pancreatitis 30 . Sensitivity & specificity of diagnosing CP with sPFTs were 82% and 86%, respectively whereas the PPV and NPV were 45% and 97%, respectively 30 . This suggests primary utility of secretin-stiumlated PFT lies in ruling out CP in patients who present with signs & symptoms concerning for CP, such as chronic abdominal pain.…”

“…Direct PFTs allow for evaluation of both acinar and ductal pancreatic cells by aspirating duodenal contents after stimulation by either CCK or secretin, respectively 30 . When stimulated by CCK, pancreatic enzymes are measured in the duodenal contents, and bicarbonate concentration is measured from the fluid following secretin stimulation.…”

“…A positive sPFT was defined as <75 mEq/l in duodenal fluid collections (collected at 15, 30, 45 and 60 minutes after stimulation). Seventy patients that were studied had negative sPFT and 20 patients had positive sPFTs 30 . Of those with positive sPFTs, 9 later developed CP where as of the 70 with negative sPFTs, only 2 patients later developed chronic pancreatitis 30 .…”

“…Seventy patients that were studied had negative sPFT and 20 patients had positive sPFTs 30 . Of those with positive sPFTs, 9 later developed CP where as of the 70 with negative sPFTs, only 2 patients later developed chronic pancreatitis 30 . Sensitivity & specificity of diagnosing CP with sPFTs were 82% and 86%, respectively whereas the PPV and NPV were 45% and 97%, respectively 30 .…”