Dynamic Secretin Stimulated Magnetic Resonance Cholangiopancreatography (D-MRCP) in Evaluating Pancreatic Function following Pancreatic Resection
Abstracts
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Purpose: To compare dynamic MRCP with diarrhoea and faecal elastase 1 activity. Methods: 17 patients (8 male, 9 female; mean age 63 years) participated. They had undergone from 44 to 83 months (mean 64 months) earlier resection of the head of pancreas. Secretin was given intravenously 10 U per 10 kilograms of body weight. MRCP was performed before secretin injection and every 30 seconds during 10 minutes. Elastase 1 was measured from all patients. They estimated the intensity of diarrhoea by using visual analogue scale (VAS). In this scale, the end points were 'no diarrhoea' (0) and 'the worst possible diarrhoea'(100). Final diagnosis was chronic pancreatitis (7 patients), distal common bile duct carcinoma (1), carcinoma of ampulla of Vater (3), cystadenoma (2) and carcinoid tumor (1). Results: Distribution of the patients according to our classification and explanation of the groups are as following: Group 0: Impossible to evaluate the pancreatic duct due to intestinal fluid (2 patients, 12 %) Group 1: Pancreatic duct not visible, no excretion to the intestine detected (6, 35 %) Group 2: Pancreatic duct visible and remains large, no excretion to the intestine detected (3, 18 %) Group 3: Excretion to the intestine is detected, pancreatic duct is visible but remains large (4, 23 %) Group 4: Pancreatic duct visible, dilates and narrows to its half, excretes to the intestine (2, 12 %). Of the 15 patients successfully examined, 5 (33 %) used pancreatic enzyme substitution. Median value of diarrhoea was 16 (range from 0 to 96). In D MRCP groups 1 and 2 there was not more diarrhoea than in groups 3 and 4 (Table 1), possibly due to enzyme substitution. In dynamic MRCP group 1 elastase 1 could not be measured in 3/6 patients, in group 2 in 3/3 and in groups 3 and 4 in 1/6 patients. There was a tendency that in dynamic MRCP groups 1 and 2 chronic pancreatitis was more often indication for operation than in groups 3 and 4. Conclusion: In comparison with elastase 1 dynamic MRCP gives an idea of pancreatic exocrine function and suggests the reason of pancreatic exocrine insufficiency (parenchymal disease or ductal stenosis) following resection of the pancreatic head. |
