Endoscopic measurement of papillary sphincter zone and pancreatic main ductal pressure in patients with chronic pancreatitis.

To determine the significance of manometric pressure of the pancreatic duct, we used a microtransducer inserted through a duodenoscope to measure pressures in the papillary sphincter zone and pancreatic main duct in 20 control subjects and 20 patients with chronic pancreatitis, and recorded the effect of exogenous glucagon or secretin. There was no significant difference between control subjects and patients with chronic pancreatitis without papillitis in the motility of the sphincter of Oddi. The pancreatic main ductal pressure was significantly higher in the patients with chronic pancreatitis (54.5 +/- 29.9 mmHg) than in the control subjects (16.2 +/- 8.7 mmHg). The viscosity of pure pancreatic juice of patients with chronic pancreatitis [5.8 centipoise (cp)] in the basal secretory state was significantly higher than that of the control subjects (1.61 cp). These data lead to the hypothesis that increased pancreatic ductal pressure in patients with chronic pancreatitis without papillitis is due not to papillary dysfunction, but to increased viscosity or other unknown factors.