A PROSPECTIVE, RANDOMIZED, CROSSOVER TRIAL IN HEALTHY SUBJECTS (HS) COMPARING ENDOSCOPIC AND DREILING TUBE (DT) COLLECTION METHODS FOR PANCREATIC FUNCTION TESTING (PFT).

Abstract

We have developed an endoscopic method that eases collection of duodenal aspirates (ePFT); however validation requires a rigorous comparison to the DT method. Aim: To compare [HCO3−] obtained by the ePFT and DT methods in HS. Methods: HS were randomized to secretin DT or ePFT, then crossed over to the remaining 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 confirmed by fluoroscopy. EPFT protocol: Endoscopy performed using a 6-mm endoscope. After IV synthetic porcine secretin (0.2mcg/kg, ChiRho-Clin, Inc.), duodenal fluid collected in 15-min increments for 1 hr and auto-analyzed for bicarbonate. Median differences in [HCO3−] were analyzed at each time point and at peak. Results: 11 HS enrolled (mean age 30yrs; 6F). [HCO3−] were not significantly different at times 30, 45, or 60; however, [HCO3−] at time 15 were significantly different [Table]. Although median peak [HCO3−] was lower for DT compared to ePFT, all HS achieved a peak [HCO3−] >80 mEq/L for both collection methods.TABLE: [HCO3 −] Values for DT and ePFTConclusions: 1. The diagnostic accuracy of ePFT is similar to DT since both collection methods demonstrate peak [HCO3−] >80 mEq/L in HS. 2. [HCO3−] is variable during the early phase of pancreatic secretion but reaches a steady state after 15 min of secretin stimulation. Clinical Implication: The secretin ePFT holds promise as an accurate and less cumbersome method of direct PFT.