Parsi Mansour A, Conwell Darwin L, Zuccaro Gregory, Stevens Tyler, Lopez Rocio, Dumot John A, Vargo John J
Center for Endoscopy and Pancreatobiliary Disorders, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Clin Gastroenterol Hepatol. 2008 Dec;6(12):1432-6. doi: 10.1016/j.cgh.2008.06.004.
BACKGROUND & AIMS: The diagnosis of chronic pancreatitis (CP) often relies on cross-sectional imaging, which may be insensitive for early disease. The aim of this study was to assess the utility of cholecystokinin pancreatic function test and endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis of CP in patients with negative or inconclusive cross-sectional imaging.
Consecutive patients with suspicion of CP and negative or inconclusive cross-sectional imaging (computerized tomography and magnetic resonance cholangiopancreatography) were evaluated with cholecystokinin-stimulated endoscopic pancreatic function test (ePFT) and ERCP. The setting was a referral center for difficult diagnostic scenarios. Pancreatograms were scored according to Cambridge classification (I-IV). The ePFT was used to determine the peak lipase concentration in pancreatic juice during timed duodenal aspiration. The gold standard for the diagnosis of CP was long-term clinical follow-up evaluation.
Thirty-five patients met the study criteria. The median duration of follow-up evaluation was 7 years (25th, 75th percentiles: 3, 7). Twenty-four of the 35 patients were diagnosed with CP based on long-term follow-up evaluation with a clinical composite reference standard. The sensitivity, specificity, and positive and negative predictive values were 96%, 37%, 77%, and 80% for ePFT and 71%, 91%, 94%, and 59% for ERCP, respectively. A low peak lipase concentration on the initial ePFT was associated with development of steatorrhea during the follow-up period (P = .02).
ePFT is a sensitive test for the diagnosis of patients with suspicion of CP and negative or inconclusive cross-sectional imaging. ERCP has modest sensitivity and high specificity for this purpose. A normal ePFT rules out CP with a high degree of certainty. An abnormal test result requires follow-up evaluation and diagnostic confirmation.
慢性胰腺炎（CP）的诊断通常依赖于横断面成像检查，而对于早期疾病，这种检查可能并不敏感。本研究旨在评估胆囊收缩素胰腺功能试验和内镜逆行胰胆管造影（ERCP）在横断面成像检查结果为阴性或不确定的患者中对CP的诊断价值。
对连续的疑似CP且横断面成像检查（计算机断层扫描和磁共振胰胆管造影）结果为阴性或不确定的患者，进行胆囊收缩素刺激的内镜胰腺功能试验（ePFT）和ERCP检查。研究地点为疑难诊断病例转诊中心。根据剑桥分类法（I-IV级）对胰管造影进行评分。ePFT用于测定定时十二指肠抽吸过程中胰液中脂肪酶的峰值浓度。CP诊断的金标准是长期临床随访评估。
35例患者符合研究标准。随访评估的中位时间为7年（第25、75百分位数：3、7）。35例患者中有24例根据长期随访评估及临床综合参考标准被诊断为CP。ePFT的敏感性、特异性、阳性预测值和阴性预测值分别为96%、37%、77%和80%，ERCP的相应值分别为71%、91%、94%和59%。初始ePFT时脂肪酶峰值浓度低与随访期间脂肪泻的发生相关（P = 0.02）。
ePFT对疑似CP且横断面成像检查结果为阴性或不确定的患者是一种敏感的诊断试验。ERCP在此目的上敏感性中等、特异性高。ePFT结果正常可高度确定排除CP。检查结果异常则需要随访评估和诊断确认。
