Introduction
Secretin is a 27 amino acid polypeptide that is released during acidification in the duodenal cavity and stimulates the secretion of water and bicarbonate by pancreatic ductal cells. To date, the only secretin used clinically is a biologically derived compound bPS extracted from the duodenum of pigs. The compound was first isolated in 1961 by Jorpes and mutt1. It is used to diagnose pancreatic insufficiency and gastrinoma, and to obtain cytological examination of exfoliated pancreatic cells for more than 20 years. It is used to promote pancreatic duct intubation in ERCP, but this indication has not been approved by the US Food and Drug Administration.
Pharmacologic action
Pancreas divisum is a developmental anomaly of pancreatic ductal anatomy. Contrast medium When the contrast agent is injected through the main nipple of the ERCP, pancreatic division is identified by the discovery of a small, terminal branch catheter system. By increasing the production of porcine secretin, small nipple holes can be easily identified, allowing juice to flow significantly into the duodenum. In addition, by increasing the flow of pancreatic juice, the orifice is enlarged, simplifying the insertion of the guidewire or catheter. Gallbladder kinin can increase the volume of porcine secretin by stimulating the production of pancreatic enzymes. More specifically, secretin increases the volume of porcine secretin and is used to promote pancreatic duct intubation in many specialized centers.
Function
The use and safety of porcine pancreatic in small papillary cannula for patients with pancreatic division when intubation is difficult. The use of this agent in a unit with expertise in pancreaticobiliary endoscopy has the potential to further increase the success rate of intubation in patients with pancreatic division. Due to the higher success rate of intubation, a higher proportion of therapeutic small nipple and dorsal tube interventions in these patients may be possible.
Pharmacokinetics and metabolism
Porcine secretin has been shown to be reliable for pancreatic function testing in healthy volunteers and in individuals with chronic pancreatitis. The half-life for secretin was approximately 4 minutes, with a clearance rate of 540 mL/min. Normal ranges for pancreatic secretory response to intravenously administered secretin in patients with defined pancreatic diseases are known to vary.
References:
1. Devereaux, B. M., Fein, S., Purich, E., Trout, J. R., Lehman, G. A., Fogel, E. L., ... & Sherman, S. (2003). A new synthetic porcine secretin for facilitation of cannulation of the dorsal pancreatic duct at ERCP in patients with pancreas divisum: a multicenter, randomized, double-blind comparative study. Gastrointestinal endoscopy, 57 (6), 643-647.
2. Somogyi, L., Cintron, M., & Toskes, P. P. (2000). Synthetic porcine secretin is highly accurate in pancreatic function testing in individuals with chronic pancreatitis. Pancreas, 21 (3), 262-265.
