Chonic Pancreatitis? Fecal Elastase or Secretin Test! - USMLE Forums
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  #1  
Old 09-16-2011
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Pancreas Chonic Pancreatitis? Fecal Elastase or Secretin Test!

diagnostic test in chronic pancreatitis?

uworld says most sensitive n most specific is fecal elastase...

Kaplan CK Notes and MTB-3 say most accurate is secretin test or serum trypsin
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  #2  
Old 09-17-2011
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Complete question would help us to determine what test would be appropriate in a specific case.

But as a general rule, to check for a hypofunctioning gland. We do stimulation test.

So i would go for the secretin stimulation test as the most sensitive test for chronic pancreatitis.
ERCP is the gold standard test for Chronic pancreatitis

Also from Medscape site;

The most accurate way to diagnose chronic pancreatitis is the administration of a hormone stimulation test such as the secretin test.
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Last edited by step1an; 09-17-2011 at 06:05 AM. Reason: Added link
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Old 09-17-2011
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I think step1an is correct.
Secretin stimulation test is the most accurate diagnostic test .
ERCP is the gold standard test, but not done routinely, because it is invasive.
Abdominal X ray is very specific, when the test is abnormal.
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Old 09-17-2011
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Quote:
Originally Posted by ag2011n View Post
I think step1an is correct.
Secretin stimulation test is the most accurate diagnostic test .
ERCP is the gold standard test, but not done routinely, because it is invasive.
Abdominal X ray is very specific, when the test is abnormal.
i think ercp could be gold std in gall stone induced ac pancreatitis...but not in chronic...what do u say?
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Old 09-17-2011
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I think it is the gold standard for chronic pancreatitis, but it is really invasive, that why not used widely, my source here is step-up to medicine.
But really I do not know for sure.
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Old 09-17-2011
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Quote:
Originally Posted by ag2011n View Post
I think step1an is correct.
Secretin stimulation test is the most accurate diagnostic test .
ERCP is the gold standard test, but not done routinely, because it is invasive.
Abdominal X ray is very specific, when the test is abnormal.
Thanks for pointing it out.
I have corrected my previous post.
so if we summarize,
Quote:
But as a general rule, to check for a hypofunctioning gland. We do stimulation test.

So, the secretin stimulation test is the most sensitive test for chronic pancreatitis.
ERCP is the gold standard test/Most accurate test for Chronic pancreatitis.
Whether its invasive or not the Gold standard usually does not change.

I remember a discussion about Pancreas related investigations a few days back.
Plz also see this thread.
Best initial test for Pancreatitis
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Old 09-17-2011
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Quote:
Originally Posted by step1an View Post
Thanks for pointing it out.
I have corrected my previous post.
so if we summarize,


Whether its invasive or not the Gold standard usually does not change.

I remember a discussion about Pancreas related investigations a few days back.
Plz also see this thread.
Best initial test for Pancreatitis
look sorry guys, im still not convinced..!! ERCP is not a gold std for chronic pancreatitis...!

secretin stimulation test is most sensitive, most specific, most accurate, n gold std, though it is invasive n seldom used...
not only kaplan n MTB 3 agree with this statement but also davidson book of med supports it..!!!

ERCP is gold std in ac pancreatitis if stones r strongly suspected, otherwise CT is the best test for ac pancreatitis..!!

plz if u have a reference to support this ercp-best test concept...do upload..!!!
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Old 09-17-2011
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My reference for that is Step up to medicine second edition, page 134.
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Quote:
Originally Posted by aasiaafzal View Post
diagnostic test in chronic pancreatitis?

uworld says most sensitive n most specific is fecal elastase...

Kaplan CK Notes and MTB-3 say most accurate is secretin test or serum trypsin
Secretin Stimulation Test for sure a best test for Chronic Pancreatitis as it tells the function of pancreas.
However, there is controversy regarding gold standard test for chronic pancreatitis. it may be secretin test or ERCP !
Also ERCP tells the pancreatic ductal structure.
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Old 09-17-2011
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There is no controversy about ERCP, it has been regarded as the Gold standard for diagnosing chronic pancreatitis.

Best diagnosis is with histology. You can take a biopsy with ERCP. I think the only thing left, which would be superior to ERCP would be to do pancreatectomy and do histopathology.

See that article form emedicine site. It explains everything

Emedicine Chronic Pancreatits
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Quote:
Originally Posted by step1an View Post
There is no controversy about ERCP, it has been regarded as the Gold standard for diagnosing chronic pancreatitis.

Best diagnosis is with histology. You can take a biopsy with ERCP. I think the only thing left, which would be superior to ERCP would be to do pancreatectomy and do histopathology.

See that article form emedicine site. It explains everything

Emedicine Chronic Pancreatits

finally convinced..!!!
n lol @ doing pancreatectomy
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Old 09-20-2011
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Quote:
Originally Posted by aasiaafzal View Post
diagnostic test in chronic pancreatitis?

uworld says most sensitive n most specific is fecal elastase...

Kaplan CK Notes and MTB-3 say most accurate is secretin test or serum trypsin
in dat uworld question serum trypsin and secretin were nt in d options so only one ov dem wud be there since they all have almost similar senitivity and specifity.
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Old 07-16-2012
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DIT specifically states that fecal elastase study most sensitive and specific test for chronic pancreatitis.

So confused !
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Old 07-16-2012
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i think for the purpose of this exam when we are asked most accurate..we should go for investigations that can spare the need for a biopsy...

Compare..Hemochromatosis...gold standard is biopsy..but best asnwer in exam is HFE gene testing

Also Prion disease ..gold standard is brain biopsy...but in exam best answer would be CSF for prion protein...


In good ol' pulmonary embolism...angiography is gold standard but best response would be Spiral CT...

The list goes on and on.......

Hence for chronic pancreatitis..gold standard is of course biopsy...but best answer is still fecal elastase or secretin stimulation test....

If we keep that in mind it may help!!
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  #15  
Old 07-17-2012
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The medscape article you posted mentions that the test with most sensitivity is duodenal aspirate test (secretin stimulation)...the later mentions that it is usually coupled with ERCP.....I think that the best answer to go with as MAT is Secretin stimulation...chronic pancreatitis is a functional problem and you can detect that using a functional test. If its a gall stone problem that is the primary issue, then ERCP would be the answer. fecal elastase is used when you have a major malabsorption issue and i believe this has less sensitivity that secretin stimulation,...but my understanding is if the question is emphasizing on the malabsorption problem, then maybe the best choice would be fecal elastase...what do you think?
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