ALTERATIONS IN PANCREATIC SECRETORY FUNCTION BEFORE AND AFTER ENDOSCOPIC PANCREATIC SPHINCTEROTOMY IN CHRONIC PANCREATITIS

Abstract

Endoscopic treatment for chronic pancreatitis have been developed in our institution since 1982. They consist of endoscopic pancreatic sphincterotomy (EPST), basket removal of calculi and placement of pancreatic endoprosthesis. We reported mainly on the clinical effect and security of these methods. Since 1986 we have started to collect pure pancreatic juice (PPJ) according to the endoscopic method by Harada et al. PPJ collection has two purposes ; for evaluating exocrine pancreatic function, and for “washing out” viscous pancreatic juice including protein plugs. This report describes the effect on pancreatic secretory function in 7 cases before and after EPST, utilizing PPJ collection and blood chemical tests (75 g OGTT, HbA1c, FBS). The follow up period is from two to 46 months after EPST. The results are as follows : Endocrine pancreatic function had no alteration in general after EPST and seemed to keep the same level as that before EPST. However, it is considered that further follow up studies will be needed to evaluate the effect on endocrine pancreatic function. On the other hand, in exocrine pancreatic function : “Volume” and “Lipase out-put” were improved by EPST (p<0.05), but “Max. HCO-3 concentration” showed no significant alteration before and after EPST. It is suggested that acinar enzyme secretory cells are tend to be damaged by ductal obstruction more easily than ductular cells, but the former is capable of improvement after a relief of ductal obstruction by endoscopic treatments.