Endoscopic manometry of the spincter of Oddi and the main pancreatic d
uct (MPD) was performed before and after intravenous injection of secr
etin (1 CU/kg) in 15 control subjects and 19 patients with chronic pan
creatitis. Secretin significantly but transiently enhanced the MPD pre
ssure in the controls, whereas chronic pancreatitis patients had an el
evated basal MPD pressure and a manometric pattern of sphincter of Odd
i 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 resp
onse to secretin in patients. The pressure enhancement was most impres
sive in chronic pancreatitis of recent onset (less than four years), w
hereas it was minimal or normal in later stages of the disease. This d
ynamic manometric test reliably demonstrates sphincter of Oddi dysfunc
tion and an altered response to secretin. The test could have a role t
o play in the explanation of progressive MPD dilatation as well as in
the early diagnosis of chronic pancreatitis.