Abstract
Endoscopic manometry of the spincter of Oddi and the main pancreatic duct (MPD) was
performed before and after intravenous injection of secretin (1 CU/kg) in 15 control
subjects and 19 patients with chronic pancreatitis. Secretin significantly but transiently
enhanced the MPD pressure in the controls, whereas chronic pancreatitis patients had
an elevated basal MPD pressure and a manometric pattern of sphincter of Oddi dyskinesia.
The secretin-induced MPD pressure was also elevated and more sustained in chronic
pancreatitis patients compared to controls. No influence of the etiology or MPD ductal
diameter was found, but the duration of the disease correlated significantly to the
pressure response to secretin in patients. The pressure enhancement was most impressive
in chronic pancreatitis of recent onset (less than four years), whereas it was minimal
or normal in later stages of the disease. This dynamic manometric test reliably demonstrates
sphincter of Oddi dysfunction and an altered response to secretin. The test could
have a role to play in the explanation of progressive MPD dilatation as well as in
the early diagnosis of chronic pancreatitis.
