ABNORMAL US RESPONSE OF MAIN PANCREATIC DUCT AFTER SECRETIN STIMULATION IN PATIENTS WITH ACUTE-PANCREATITIS OF DIFFERENT ETIOLOGY

To assess changes in caliber of the main pancreatic duct, we performed abdominal ultrasonography after maximal stimulation with secretin (US -S test) in 14 patients with idiopathic recurrent acute pancreatitis, in six with recurrent acute pancreatitis secondary to pancreas divisum , in 14 recovered from a single attack of acute pancreatitis, and in 2 1 control subjects. In five patients, the test was repeated 10 days af ter endoscopic sphincterotomy. We repeated the test 48 h later in nine subjects to evaluate its reliability. We evaluated changes in lipase serum values in some of these subjects. In the acute pancreatitis pati ents, the main pancreatic duct diameter was significantly increased ov er baseline and control values throughout the observation period. In t he patients undergoing sphincterotomy, the poststimulation diameter of the main duct was substantially reduced after the operation. The reli ability of the test ranged from 77 to 91.5%. In the acute pancreatitis patients, serum enzymes after secretin stimulation showed a persisten t increase over controls. These results suggest that pancreatic outlet obstruction, mainly at the sphincter of Oddi level, may be an importa nt pathogenetic factor in the course of the disease and that, if this condition is present after an attack of acute pancreatitis, endoscopic sphincterotomy may be in order. The simplicity and satisfactory repro ducibility of the US-S test suggest a strong case for its routine clin ical use.