ERCP in pancreatic disease

The Lundh test and endoscopic retrograde cholangiopancreatography (ERCP) were used to investigate 40 patients with known or suspected pancreatic disease. Pancreatograms were classified as being normal or showing minimal or gross changes. There was good correlation between the two tests in assessing the degree of pancreatic disease (p < 001). Gross radiographic changes were associated with a mean tryptic activity (MTA) of < 6 IU/ml, while minimal changes were associated with an MTA between 6 and 14 IU/ml. Although some patients with normal pancreatograms had MTAs within this range, no patients with an MTA above 14 IU/ml had an abnormal pancreatogram. The Lundh meal is of great value in detecting extensive pancreatic disease and an unequivocally normal result virtually excludes significant chronic pancreatic disease. Values in the equivocal range usefully draw attention to early pancreatitis which may be confirmed by ERCP. In this paper the interpretation of pancreatograms is discussed and the clinical features of the patients with minimal change disease are reviewed.