Comparison of ultrasound-secretin test and sphincter of Oddi manometry in patients with recurrent acute pancreatitis

Manometry is considered the gold standard for evaluating sphincter of Oddi dysfunction. It has recently been demonstrated that the ultrasound (US) sec retin test proposed a few years ago as a noninvasive test for the study of sphincter of Oddi dysfunction yields a substantial percentage of pathologic al findings in patients with acute recurrent pancreatitis. The aim of this study was to compare the results of the US secretin test with sphincter of Oddi manometry findings in a consecutive series of patients with recurrent acute pancreatitis. Forty-seven patients admitted to our gastrointestinal u nit suffering from recurrent acute pancreatitis underwent ultrasonographic measurement of the main pancreatic duct at baseline and for 60 min after ma ximal stimulation with secretin at 1 IU/kg. According to the US secretin te st findings in 35 healthy control subjects, the test results were considere d to indicate pathology when the duct was still dilated after 20 min. Withi n three to seven days the same patients underwent perendoscopic manometry. Thirty-six patients (17 men, 19 women mean age 41 +/- 15 years) had a succe ssful US secretin test and sphincter of Oddi manometry. Eleven patients (30 .6%) presented normal manometric findings. Two of these had an abnormal US secretin test. Twenty-five patients had abnormal manometry findings, reveal ing stenosis in 19 (52.7%) (17 with abnormal US secretin test) and dyskines ia in six (five with an abnormal US secretin test). Compared to manometry f indings, the US secretin test sensitivity and specificity for sphincter of Oddi dysfunction were 88% and 82%, respectively. In conclusion, most patien ts with recurrent acute pancreatitis have sphincter of Oddi dysfunction doc umented by both at the US secretin test and sphincter of Oddi manometry; re sults of the US secretin test are reliable compared to sphincter of Oddi ma nometry, and therefore the US secretin test may offer a valid alternative t o the more expensive and invasive manometric procedure for assessing sphinc ter of Oddi dysfunction in patients with recurrent acute pancreatitis.