Diagnosis & TreatmentDiagnostic Techniques

Diagnosis of Pancreatic Diseases

There are a variety of tests used to determine if pancreatic disorders are present, what kinds and how advanced they are, and what may be causing the problem.

Abdominal Ultrasound

Abdominal ultrasound is a non-invasive technique using directed sound waves to examine the body's internal organs, including the pancreas, gallbladder, liver, kidneys, spleen, stomach, and intestines.

During this examination, the patient lies horizontally with abdomen exposed. The technologist who performs the exam, called a sonographer, spreads a gel on the skin's surface and then passes a hand-held instrument called a transducer around the surface of the abdomen. The gel enables smooth manipulation of the transducer and helps to transmit the sound waves by excluding air. Commonly, patients are asked to fast for 6 to 8 hours prior to the test; water and routine medications may be consumed. The test is completely painless and lasts about twenty minutes.

The test yields a printed scan, similar to a doppler effect image, that is read by the technician and your physician.

MRI Scan

MRI is another non-invasive diagnostic procedure commonly prescribed at the Pancreas Center. MRI combines the use of a large magnet and radio waves to create body images. The hydrogen atoms in a patient's body react to the magnetic field, a computer reads the resulting data and organizes the data into images that can be read by the radiologist. To prepare for an abdominal MRI, patients are asked to refrain from eating or drinking at least 6 hours prior to the exam, while continuing to take any medications with water as usual. Jewelry and makeup should not be worn during the scan, as they may interfere with obtaining accurate results. Patients with cardiac pacemakers or who have had certain kinds of neurosurgery or orthopedic surgery should not have MRI scans.

CT Scan

A CT scan (also known as CAT scan) is another non-invasive diagnostic test. Utilizing computer analysis of multi-angle X-ray images to create cross-section views of the body, this technique can show internal organs, bones and tissues in great detail. Patients are asked to refrain from eating for three hours prior to testing. Medications and fluids may be taken. Often, contrast dyes are administered by IV to enhance the resulting image. During the test the patient lies flat on a movable table that is slowly moved into a large circular opening the CT machine where the series of images are made.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

ERCP is an X-ray visualization of the ducts leading from the pancreas and gallbladder used to diagnose the presence of stones or tumors in these ducts.

To prepare for the test, the patient is asked to fast for 12 hours and is usually given a sedative or tranquilizer at the start of the procedure. A local anesthetic in spray or gargle form is used to suppress gagging and causes the patient to loose some control of saliva. A mouth guard may be inserted to protect the teeth.

In this procedure, which lasts about an hour, a long, flexible tube known as an endoscope is inserted into the mouth and down the throat while the patient swallows to help pass it down the esophagus. Guided by fluoroscopic X-ray imaging, the doctor passes the endoscope into the stomach and duodenum. A drug is injected into the duodenum to relax it. Next, a contrast medium is injected through the endoscope and a series of X-rays is taken. Another set of X-rays may be taken from another position once the endoscope is removed.

The patient may feel side effects from the drug or hormone used to relax the duodenum and from the contrast medium. These include nausea, hives, blurred vision, dry mouth, urinary retention, and a feeling of burning or flushing. The throat may be sore for several days afterward. ERCP may also be used for follow up examination of endoscopic sphincterotomy or other therapeutic procedures.

Angiography

This is a radiologic test to examine the blood vessels in and around the pancreas. Under local anesthesia, a small catheter is inserted into the artery of the upper thigh. Contrast dye is injected into the vessels leading to the pancreas through the catheter and an X-ray image of the vessels is taken. These images help assist with the planning and undertaking of surgery. Because of the invasive nature of angiography, we use this procedure only when results of other tests or information is inconclusive.

Laparoscopy

To find out if a pancreatic tumor has spread to other organs or tissues a minimally-invasive surgical technique called laparoscopy may be advised. This procedure is conducted in the operating room under general anesthesia. A fiber-optic laparoscope, essentially a tiny camera, is guided into the abdomen through a small incision. Viewing the images from this small imaging device on a screen, the surgeon can directly examine the internal organs without making a full abdominal incision.

Biliary and Pancreatic Manometry

This is a technique used in the diagnosis of Sphincter of Oddi dysfunction (SOD) which may be a cause of pancreatic/biliary pain or idiopathic pancreatitis. During ERCP a small catheter is placed inside the bile and pancreatic ducts to measure pressure inside the sphincter. Elevated pressures indicate the presence of SOD. Patients with high pressures would be treated with sphincterotomy to resolve their symptoms. The preparation for this test is the same as for ERCP.

Endosonography-Guided Fine-Needle Aspiration (EUS-FNA)

Endoscopic ultrasound or endosonography (EUS) is now recognized as the most accurate method for detecting pancreatic masses. To determine if a mass is benign or malignant, EUS-guided needle biopsy can be performed on any mass detected during the EUS imaging procedure to yield a secure diagnosis.