Combined Functional and Morphological Diagnostic Approach in Chronic Pancreatitis

Abstract

The first nonsurgical diagnostic access for the detection of chronic pancreatic disease became possible by the introduction of function testing [2, 5, 8]. At this historic point of pancreatic investigation the only morphological criterion of imaging procedures for chronic pancreatitis was the radiological appearance of calcifications. The past decade has seen significant developments in morphological methods, and earlier diagnosis of chronic pancreatitis is now possible [3; Lees, this volume]. Since each of these methods requires specialized equipment and training, the idea that these groups of technologies might be in competition rather than complementary has developed. Although function tests have been developed to a similar degree [6], they have declined in importance, and some investigators now define them as obsolete in view of the refined imaging techniques. Studies comparing the value of endoscopic retrograde pancreatography (ERP) with the secretin CCK test in the diagnosis of chronic pancreatitis have revealed a similar sensitivity of the two methods, slightly favoring either ERP [7, 14] or the function test [11, 13, 15]. Oguri [12] and Braganza et al. [1] found a positive correlation between the degree of the exocrine functional impairment and the severity of ductal changes in chronic pancreatitis. We extended this study by comparing different degrees of parenchymal lesions revealed by computed tomography (CT) and of ductal alterations (ERP) with the degree of exocrine functional impairment [10]. Exocrine function was studied by means of the secretin ceruletide test (SC), procedure already published elsewhere [9] and graded as shown in Table 1. Criteria for the graduation of morphological changes are reported in Table 2 (ERP, CT).