4665 Secretin-stimulated functional mrcp: correlation with sphincter of oddi manometry.

Abstract

INTRODUCTION : Reports suggest that the pancreatic duct (PD) may remain dilated for a longer time following secretin administration in pts with Sphincter of Oddi dysfunction(SOD), and thus may be able to predict elevated pancreatic basal sphincter pressure. AIM: To determine if pancreatic basal sphincter pressure elevation can be predicted by secretin stimulated functional magnetic resonance cholangiopancreatography (MRCP). METHODS : Pts with idiopathic pancreatitis or pancreaticobiliary abdominal pain who were scheduled for ERCP with SOM were eligible to participate. Seventy-two pts were recruited and underwent secretinstimulated MRCP; 42 had both MRCP and ERCP with SOM. Secretin was administered IV (1 CU/kg) and MRCP imaging performed on a 1.5 T General Electric Signa scanner using a single-slab technique with a singleshot, half-Fourier, fast spin echo pulse sequence. Imaging was repeated over a 30-minute period and measurements of the PD diameter were made at four anatomic locations on each scan. SOD was diagnosed when the basal pressure was ≥ 40mmHg. Pts with pancreas divisum were excluded. RESULTS: Of the 42 pts who underwent both studies 14 (M:F 6:8) had normal pancreatic manometry and 28 (M:F 9:19) had elevated pancreatic basal sphincter pressure. SUMMARY: Secretin-stimulated MRCP shows a diminished, rather than exaggerated, ductal dilation response in patients with documented SOD. CONCLUSIONS: The limited ductal diameter changes are suggestive of chronic pancreatitis. Further correlation studies evaluating other parameters for detecting subtle chronic pancreatitis are needed.