Dynamic endoscopic manometry of the response to secretin in patients with chronic pancreatitis

Endoscopic manometry of the sphincter of Oddi and the main pancreatic duct (MPD) was performed before and after intravenous injection of secretin (1 CU/kg) in 15 control subjects and 19 patients with chronic pancreatitis. Secretin significantly but transiently enhanced the MPD pressure in the controls, whereas chronic pancreatitis patients had an elevated basal MPD pressure and a manometric pattern of sphincter of Oddi dyskinesia. The secretin-induced MPD pressure was also elevated and more sustained in chronic pancreatitis patients compared to controls. No influence of the etiology or MPD ductal diameter was found, but the duration of the disease correlated significantly to the pressure response to secretin in patients. The pressure enhancement was most impressive in chronic pancreatitis of recent onset (less than four years), whereas it was minimal or normal in later stages of the disease. This dynamic manometric test reliably demonstrates sphincter of Oddi dysfunction and an altered response to secretin. The test could have a role to play in the explanation of progressive MPD dilatation as well as in the early diagnosis of chronic pancreatitis.