7238 Facilitation of pancreatic duct cannulation using synthetic porcine secretin.

Abstract

INTRODUCTION: Secretin, for diagnostic use, is a gastrointestinal peptide hormone consisting of 27 amino acids. Its primary pharmacologic action is to increase the volume and bicarbonate content of secreted pancreatic juices. Its approved uses are for the diagnosis of chronic pancreatitis and gastrinoma and as an adjunct to obtain pancreatic cells for cytology. Previously, only secretin extracted from porcine duodenums had been available. Recently, a pure synthetic porcine secretin (ChiRhoClin) with an identical amino-acid sequence and structure has been developed. AIM: To assess the pharmacological and clinical efficacy and safety profile of this new synthetic porcine secretin in facilitating cannulation of either the major or minor pancreatic orifice at ERCP. METHODS: In this prospective study, patients were administered 0.2ug/kg IV (max. 16ug) of synthetic porcine secretin if protracted efforts to locate or cannulate the major or minor pancreatic orifice had failed. Exclusion criteria were acute pancreatitis, known sensitivity or adverse reaction to secretin and pregnant or nursing females. RESULTS: Between March and November, 1999, 29 patients were enrolled (M:F 8:21; Average age 52.8 years, range 23-81 years). The indications for secretin injection were: to aid in minor papilla cannulation in patients with pancreas divisum (18), to aid in finding main PD orifice (4), to find PD orifice post biliary sphincterotomy (3), to facilitate intact major papilla cannulation (2), to aid in finding minor papilla (1), and to facilitate minor papilla cannulation in normal PD anatomy (1). Successful cannulation was achieved in 26/29 (89.7%) patients. In one case, cannulation of the minor papilla was still not possible because of its location in a duodenal diverticulum. In the two remaining cases, deep cannulation of the pancreatic duct was not deemed essential and was not pursued. No adverse events were recorded. SUMMARY: A new, pure, synthetic secretin aided successful cannulation of the major or minor pancreatic orifices in 26/29 patients in whom protracted efforts to locate or cannulate the pancreatic duct had failed. These data suggest this new agent is both effective and safe for this clinical indication. CONCLUSIONS: Synthetic porcine secretin is a safe and useful agent, and its administration can be added to the armamentarium of techniques to facilitate pancreatic duct cannulation.