Digestive Health

Diagnostic Procedures

If you are scheduled to undergo a diagnostic procedure, please review the Preparation Instructions.

Endoscopic Ultrasound (EUS)

For pancreatic disorders, we use special endoscopes to study the pancreas. One increasingly common endoscopic procedure uses an ultrasound probe at the tip. This is called Endoscopic Ultrasound (EUS). This allows our gastroenterologists to study the pancreatic tissue carefully under ultrasound and detect abnormalities such as pancreatic masses, cysts or other changes that might be seen in chronic pancreatitis.

In addition to visualizing abnormalities, our specialists can take tissue or fluid samples under ultrasound guidance with a technique called fine needle aspiration (FNA). Under direct visualization, your doctor can avoid important blood vessels and make a diagnosis. The most common example of this includes diagnosing the cause of a newly discovered mass in the pancreas.

Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

Endoscopic retrograde cholangio-pancreatography (ERCP) is another special endoscope available for the study of pancreatic disorders. This endoscope is maneuvered into the small bowel at the entrance of the bile duct and pancreatic duct. We can access the duct with special tools that allow contrast to be injected into the bile or pancreatic duct.

Radiographic images are then taken after contrast injection delineates the ductal anatomy. This is very helpful to evaluate for any abnormalities that could be causing pancreatitis, including stones in the bile and/or pancreatic duct, or strictures in the bile and/or pancreatic duct.
If abnormalities are identified, we can perform appropriate treatments or diagnostic tests. In the example of stones, our specialists can carefully extract them. For strictures, our specialists can take brushings to determine a cause and treat them by dilating them using a small balloon. We can place plastic or metal stents in the ducts to keep them open. In some cases, we can safely cut the muscles of the ducts to keep them open to prevent further obstructions from stones.

Pancreatic Function Testing

Pancreatic Function testing can be a sensitive way to diagnosis early chronic pancreatitis.
Early forms of chronic pancreatitis can be difficult to detect because images of the pancreas and indirect tests of pancreatic function may be normal. Our specialists can perform pancreatic function testing using the endoscope to detect early-stage chronic pancreatitis, and determine a pancreatic cause for unexplained chronic diarrhea.

The patient is sedated and the endoscope is passed into the small bowel at the location of the ampulla, which is formed by the union of the pancreatic and common bile ducts. Synthetic human secretin is administered intravenously to the patient and pancreatic juice is collected at 15 minute intervals for 60 minutes.

The pancreatic juice is collected to measure the bicarbonate concentration. Adequate production and secretion of bicarbonate implies intact functioning of the pancreas.

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