Comparison of pancreatic morphology and exocrine functional impairment in patients with chronic pancreatitis.

Abstract

A comparative analysis of pancreatic morphology and exocrine function was performed prospectively in 48 patients. All patients had transabdominal ultrasound, computed tomography, endoscopic retrograde pancreatography, and a secretin-caerulein test. Classification of ultrasound, computed tomography, and pancreatogram findings was based on the Cambridge classification. In 10 patients, no pancreatic duct changes were detected on pancreatography. Equivocal (Cambridge I), mild to moderate (Cambridge II), and considerable ductal changes (Cambridge III) were found in 10, 12, and 16 patients, respectively. Computed tomography and ultrasound changes were found to correlate in 40-50%, 67%, and 94-100% of patients with Cambridge I, II, and III abnormal duct morphology, respectively. In patients with a normal pancreatogram, no patient had a functional impairment. Seventy per cent of the patients with equivocal pancreatic duct changes had dissociated, and 30% global, pancreatic insufficiency, while 50% of those with mild to moderate abnormal duct morphology manifested dissociated, and 50% global, functional impairment. All patients with considerable pancreatic duct changes had global pancreatic insufficiency. The results of this study confirm that normal endoscopic retrograde pancreatographic findings and Cambridge III ductal changes on endoscopic retrograde pancreatography correlate extremely well with normal pancreatic function and advanced functional insufficiency, respectively. As diagnostic tools, ultrasound and computed tomography are as sensitive as pancreatography only in chronic pancreatitis with considerable morphological changes.