Modified serum pancreolauryl test in chronic pancreatitis: evaluation in comparison to endoscopic retrograde pancreatography

Abstract

Background/aims: The aim of this study was to assess the applicability and accuracy of the modified serum pancreolauryl test (sPLT) in patients with chronic pancreatitis (cP).

Methodology: We compared the results of a modified serum pancreolauryl test to morphological changes as detected by endoscopic retrograde pancreatography (ERP) in 60 patients with a history suggesting chronic pancreatitis were compared. Serum fluorescein was measured 30, 60, 120, 150, 180 and 240 minutes after the ingestion of fluoresceindilaureat, a standardized breakfast, and i.v. administration of secretin (1 U/kg) and metoclopramide (10 mg). Furthermore, the results of sPLT and ERP were compared to the findings on abdominal ultrasonography.

Results: Forty of 60 patients suffered from cP according to ERP criteria. With a fluorescein cut-off point of 4.5 micrograms/ml, sPLT reached a sensitivity of 68% and a specificity of 50%. According to the ROC curve, the optimal cut-off point was at a fluorescein level of 4.1 micrograms/ml; however, predictive accuracy was only slightly improved at this point. In the subgroup of patients with advanced pancreatic duct changes (n = 23), however, sPLT reached a sensitivity of 87% with 16 patients showing a peak fluorescein concentration below 2.5 micrograms/ml.

Conclusion: Like other indirect pancreatic function tests, modified sPLT provides good recognition of patients with advanced cP but poor identification of patients with mild or moderate cP, leading to an unsatisfying overall performance of the test.