April 2023 Newsletter

EUS
The advent of endoscopic ultrasound (EUS) provides ultra-high resolution images and exquisite details of pancreatic tumors, particularly in cystic lesions.
Additionally, EUS allows simultaneous tissue sampling of pancreatic lesions with EUS-guided fine needle aspiration (FNA). The acquisition and interpretation of these images are usually performed by interventional gastroenterologists.
EUS and endoscopic secretin pancreatic function test (ePFT) may be combined in a single endoscopic session (EUS/ePFT) to diagnose chronic pancreatitis (CP)³.
The two-sample ePFT serves as a useful adjunct to advanced endoscopic procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and EUS. Patients with borderline or equivocal two-sample ePFT results should be considered for the 1-hour five-sample collection method.

ERCP
Endoscopic cholangio-pancreatography (ERCP) is a frequently employed second-step procedure to detect biliary and pancreatic abnormalities in patients with acute recurrent pancreatitis (ARP) of unknown aetiology. ERCP combines upper gastrointestinal (GI) endoscopy and x-rays to treat problems of the bile and pancreatic ducts. Doctors use ERCP to diagnose problems of the bile and pancreatic ducts if they expect to treat problems during the procedure, but prefer more noninvasive tests – tests that do not physically enter the body – which are safer and can also diagnose many problems of the bile and pancreatic ducts. For patients who undergo the procedure, a common post-ERCP complication is pancreatitis. Synthetic secretin is effective in reducing post-ERCP pancreatitis.⁴

MRCP
Magnetic resonance cholangiopancreatography (MRCP) has been used for non-invasive evaluation of the pancreas for several decades, providing excellent visualization of the pancreatic and biliary ductal systems. However, despite being the most accurate tool for pancreas imaging, the limiting nature of static imaging affects the providers’ assessment of pancreatic response to stimulation and real-time pancreatic function.

Secretin Enhanced magnetic resonance cholangiopancreatography (S-MRCP) allows physicians to assess the endocrine function of the pancreas in real time. The visualization of the pancreas is transformed from a static image (MRCP) to high temporal resolution images, which in turn is useful for getting a complete picture of the pancreatic response in physiologic condition and obtaining functional information.