SECRETIN-PANCREOZYMIN TEST (SPT) AND ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) - BOTH ARE NECESSARY FOR DIAGNOSING OR EXCLUDINGCHRONIC-PANCREATITIS

Results of the SPT and the ERCP staged for their severity were compare d in 202 patients. The correlation between both investigations was sig nificant (p < 0.001); however, ERCP showed significantly more severe c hanges (p = 0.04). Furthermore, we found that 129 (64%) patients had p arallel SPT and ERCP results, matching in all four gradings of severit y. Forty-three (21%) patients had abnormal results for both SPT and ER CP, but the severity gradings did not parallel. Finally, 30 (15%) pati ents showed totally nonparallel results, a normal SPT and abnormal ERC P, or vice versa. Abnormal ERCP but normal SPT results were found in 2 3 of these 30 patients (group 1), and normal ERCP but abnormal SPT res ults in the seven remaining cases (group 2). In the first group, more patients had a history of acute pancreatitis compared to the second gr oup (19 vs. one, p < 0.005). Based on medical history, laboratory and functional test results, and other morphological tests, chronic pancre atitis was diagnosed in two of 23 patients in group 1 and in all seven patients in group 2. Follow-up interviews (86 +/- 54 months) were pos sible in 20 of the remaining 21 patients in group 1 and showed definit e chronic pancreatitis in one and probable chronic pancreatitis in ano ther two of them, whereas in the other 17 patients no symptoms of acut e pancreatitis or abdominal pain suggestive of chronic pancreatitis ha d occurred. In conclusion, both SPT and ERCP should be used to complem ent each other when chronic pancreatitis is suspected. ERCP seems to o verdiagnose the disease since duct changes may only reflect scars afte r severe acute pancreatitis, or old age, and are not necessarily a sig n of chronic pancreatitis. SPT seems to diagnose chronic pancreatitis with more reliability.