Update on endoscopic pancreatic function testing

Hormone-stimulated pancreatic function tests (PFTs) are considered the gold standard for measuring pancreatic exocrine function. PFTs involve the administration of intravenous secretin or cholecystokinin, followed by collection and analysis of pancreatic secretions. Because exocrine function may decline in the earliest phase of pancreatic fibrosis, PFTs are considered accurate for diagnosing chronic pancreatitis. Unfortunately, these potentially valuable tests are infrequently performed except at specialized centers, because they are time consuming and complicated. To overcome these limitations, endoscopic PFT methods have been developed which include aspiration of pancreatic secretions through the suction channel of the endoscope. The secretin endoscopic pancreatic function test (ePFT) involves collection of duodenal aspirates at 15, 30, 45 and 60 min after secretin stimulation. A bicarbonate concentration greater than 80 mmol/L in any of the samples is considered a normal result. The secretin ePFT has demonstrated good sensitivity and specificity compared with various reference standards, including the "Dreiling tube" secretin PFT, endoscopic ultrasound, and surgical histology. Furthermore, a standard autoanalyzer can be used for bicarbonate analysis, which allows the secretin ePFT to be performed at any hospital. The secretin ePFT may complement imaging tests like endoscopic ultrasound (EUS) in the diagnosis of early chronic pancreatitis.This paper will review the literature validating the use of ePFT in the diagnosis of exocrine insufficiency and chronic pancreatitis. Newer developments will also be discussed, including the feasibility of combined EUS/ ePFT, the use of cholecystokinin alone or in combination with secretin, and the discovery of new protein and lipid pancreatic juice biomarkers which may complement traditional fluid analysis.

Endoscopic vs external dacryocystorhinostomy-comparison from the patients' aspect

·AIM: To compare the success and complication rates,duration of surgeries and clinical comfort after endoscopic dacryocystorhinostomy(END-DCR) or external dacryocysto-rhinostomy(EXT-DCR).·METHODS: Fifty patients who underwent EXT- or END-DCR between January 2010-2012 were involved in the study. A questionnaire was applied to patients preoperatively, and postoperatively. Subjective success was defined by absence of epiphora, objective success by a normal nasolacrimal lavage and a positive functional endoscopic dye test(FEDT). Postoperative pain and cosmetic result of surgery were interpreted by the patients, who were also asked whether they would offer this surgery to a friend or would prefer this surgery once more if necessary.·RESULTS: Twenty-five patients underwent END-DCR and 25 underwent EXT-DCR. Mean duration of surgeries were 35 min both for EXT-DCR(30-50) and END-DCR(35-50)(P =0.778). Intraoperative bleeding were documented in 48% of EXT-DCR and 4% of END-DCR cases(P 【0.001). In total 96% of EXT-DCR and 100% of END-DCR patients had subjective success. Objective success was 100% in each group. There was no significant difference between the epiphora scorings and FDDT results in postoperative visits among the groups.END-DCR group reported less pain in first week and month(P 【0.05, P 【0.05). More patients in END-DCR group were happy with the cosmetic result in first week and month(P 【0.001, P 【0.001). More patients in END-DCR group offered this surgery to a friend(P 【0.001). All patients in END-DCR group preferred this surgery once more if necessary, only 48% in EXT-DCR preferred the same method(P 【0.001).·CONCLUSION: Although both END- and EXT-DCRs provide satisfactory outcomes with similar objective andsubjective success rates, we demonstrated that the endonasal approach caused significantly less pain in early postoperative period than the external approach.Clinical comfort defined by the patients was quite higher in END-DCR group, in which patients mainly were pleased to encounter a sutureless surgical area.