A Randomized Crossover Study of Secretin-Stimulated Endoscopic and Dreiling Tube Pancreatic Function Test Methods in Healthy Subjects

• Published in: The American journal of gastroenterology Vol. 101; no. 2; pp. 351 - 355
• Main Authors: Stevens, Tyler, Conwell, Darwin L., Zuccaro, Gregory, Van Lente, Frederick, Purich, Edward, Khandwala, Farah, Fein, Seymour
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing 01.02.2006; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Adult; Bicarbonates - metabolism; Biological and medical sciences; Cross-Over Studies; Duodenoscopy - methods; Duodenum - metabolism; Female; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Agents; Humans; Hydrogen-Ion Concentration; Intestinal Secretions - chemistry; Intubation, Gastrointestinal - methods; Male; Medical sciences; Middle Aged; Pancreas - secretion; Pancreatic Function Tests; Reference Values; Secretin; Human; Gastrointestinal hormone; Healthy subject; Gastroenterology; Secretin; Endoscopy; Pancreas
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1111/j.1572-0241.2006.00407.x

We have developed an endoscopic method of secretin endoscopic pancreatic function testing (ePFT) to simplify duodenal fluid collection. Validation of the ePFT requires a direct comparison to the traditional PFT using a Dreiling tube (DT). Our aim was to compare bicarbonate concentrations [HCO3-] obtained by the ePFT and DT methods in healthy subjects (HS). HS were randomized to either DT or ePFT, then crossed over to the other test after a minimum 1-wk washout. An age/weight-based sedation bolus was used for each test. DT protocol: Endoscopic placement of a DT was confirmed by fluoroscopy. After a baseline 15-min collection and administration of IV synthetic secretin, fluid was continuously collected in 15-min aliquots for an hour. ePFT protocol: Endoscopy was performed using a 6-mm endoscope. After gastric aspiration and discard and IV secretin, duodenal aspirates were obtained every 15-min for an hour. Fluid specimens were auto-analyzed for [HCO3-]. Twelve HS were enrolled (6F, mean age 37 yr). The difference in [HCO3-] between the two methods was not significant at the 0-, 30-, 45-, or 60-min collections. An excellent correlation in peak [HCO3-] was observed (R2 = 0.84, p < 0.001). Using a peak [HCO3-] cutpoint 80 mEq/L, there was 100% agreement between the methods; using cutpoint 90 mEq/L, there was 83% agreement. The accuracy of the ePFT is similar to DT: There were minimal differences in [HCO3-] at each of the timed collections and at peak. There is an excellent correlation in peak [HCO3-] and high level of diagnostic agreement between the tests.