Pancreas Tests

What are pancreas tests?

Pancreas tests help healthcare providers evaluate the health of your pancreas. Your pancreas is an important organ in your digestive system. It releases digestive enzymes that help break down proteins and fats in your diet, allowing your body to retrieve the nutrients it needs. It also releases hormones to neutralize stomach acid and regulate blood sugar levels. A poorly functioning pancreas can be painful and lead to a variety of digestive problems, which worsen over time if they aren't treated. Pancreas problems can also cause problems for other organs, and they can indicate other underlying conditions.

What are the different types of pancreas tests?

Healthcare providers use several different types of tests to check your pancreas for problems. Pancreas function tests look for certain chemicals in your blood or poop that can tell your provider how well your pancreas is doing its jobs. Providers also use imaging tests to visualize your pancreas and look for signs of distress. These tests can help screen you for conditions such as pancreatitis and pancreatic cancer.

• Pancreas function tests evaluate the chemical functioning of your pancreas. These tests tell healthcare providers whether your pancreas is producing the right chemicals in the right amounts at the right time. Some tests measure enzyme levels in your blood or in your poop. Another test stimulates your pancreas with a hormone and then measures what chemicals the pancreas produces in response. Your provider will recommend a particular test based on your unique condition. If your results are abnormal, they may indicate a disease of the pancreas.
• Imaging tests help providers see the condition of your pancreas. They might look for signs of inflammation and swelling or for abnormalities such as pancreatic cysts or gallstones, an abscess or a tumor. If you have a chronic condition, images may show signs of long-term damage, such as scarring and calcification. Common imaging tests include CT scans, ultrasounds and MRIs.
• Tests for pancreatic cancer are usually imaging tests. If images show something that might be cancer, your provider will then order a biopsy — a sample of the cells to look at under a microscope — to confirm the diagnosis. Researchers are working to develop a blood test that could help catch pancreatic cancer earlier in people with higher risk, such as those with a genetic history of the disease. The blood test identifies certain biological substances in the blood that are associated with pancreatic cancer. But it’s not yet accurate enough for common use.

What can I expect during my pancreas test?

Some medical tests are more invasive than others. That means some might be more demanding or uncomfortable for you, while others are relatively easy. Technically, an “invasive” test is one that requires a healthcare provider to enter your body with an instrument, such as a tube. Healthcare providers often prefer to start with noninvasive tests, if possible, but sometimes more intensive measures are required to get to the root of your problem.

Noninvasive pancreas tests include:

Blood tests. A pancreas blood test is considered a noninvasive test. It involves having a small amount of blood drawn from a needle in one of your veins, usually in your wrist. Your healthcare provider will send the blood sample to a lab to analyze. This is often the first step healthcare providers take to check how well your pancreas is functioning, especially if your symptoms are new. The blood test measures levels of pancreatic enzymes in your blood — either amylase or lipase. If your enzyme levels are three times higher than normal, that indicates pancreatitis. Your healthcare providers will follow up on these results with an imaging test to confirm the diagnosis and isolate the cause.

Stool test. A stool test is another type of pancreas function test. Your healthcare provider might use a stool test to help diagnose a more chronic condition if you’ve had ongoing symptoms for a while, or if they went away and then came back. This means you will hand over a sample of your poop for analysis. The stool test checks for reduced levels of enzymes in your stool. If elastase is low — or if chymotrypsin is absent — it means that your pancreas is no longer producing enough digestive enzymes to break down food in your small intestine. This is called exocrine pancreatic insufficiency (EPI). An excess level of fat in your stool is another possible sign of pancreatic insufficiency.

Abdominal ultrasound. An abdominal ultrasound is a common imaging test for evaluating the organs in your abdomen. To look at the pancreas, your healthcare provider will conduct an “upper right quadrant” abdominal ultrasound, which shows the pancreas, liver and gallbladder. The ultrasound works by bouncing sound waves off of the soft tissues in your abdomen. You’ll lie comfortably on a table while a trained medical professional applies a special gel to the area. It might be a little cold. Then they will move a probe over the gel. The probe will produce digital images of the area on a screen as it moves. Ultrasound images can show signs of inflammation in your organs, as well as other abnormalities, such as growths or gallstones affecting your pancreas.

Magnetic resonance cholangiopancreatography (MRCP). MRCP is a kind of magnetic resonance imaging test (MRI) that uses strong magnets and radio waves to produce images. It’s more sensitive than an ultrasound, and it doesn’t use radiation like an X-ray. If your healthcare provider needs a clearer view of your pancreas and pancreatic duct, they might recommend this test next. While the MRI is noninvasive, some people choose to be medicated (sedated) to help them relax. The test involves lying very still on a scanning bed inside a partially enclosed machine for about an hour. There are loud knocking and clicking noises throughout the test. You can wear earplugs or headphones if you choose, and you can communicate with the technologist whenever you need to.

Computed tomography (CT) scan. A computed tomography (CT) scan, also known as a CAT scan, is a kind of X-ray that produces 3-D images of your insides. Your healthcare provider may recommend a CT scan if they haven’t been able to confirm your diagnosis through other means, or if you’re not recovering as quickly as expected and they need more information. The test uses a small amount of radiation, which is not considered harmful unless you are pregnant. It also uses a contrast dye inside your body to make the parts show up. You will either drink the dye in a solution or it will be injected into your vein. Then you will lie on a scanning bed as it moves slowly through a donut-shaped scanner. Unlike the MRI, a CT scan is silent and only takes 10-30 minutes.

More invasive pancreas tests include:

Secretion stimulation test. The secretin stimulation test is a kind of pancreatic function test that’s a little more invasive than a blood test or stool test. Healthcare providers won’t typically recommend this test first if your symptoms are new and they only suspect an acute, temporary condition. But they might use it to help diagnose a more chronic condition of the pancreas, such as chronic pancreatitis, cystic fibrosis or pancreatic cancer. This test can help identify chronic conditions earlier than a stool test.

The secretin stimulation test measures how well your pancreas responds to the hormone secretin. Your small intestine produces secretin naturally in the presence of partially digested food. Normally, secretin stimulates your pancreas to secrete a fluid with a high concentration of bicarbonate, which helps neutralize stomach acid and break down food in your small intestine. The secretin stimulation test measures the bicarbonate levels that your pancreas produces in response to a secretin injection.

For the test, your healthcare provider will inject secretin into your vein to stimulate your pancreas. Then they will place a nasogastric tube through your nose and down your throat into the upper section of your small intestine (duodenum), where secretin and bicarbonate normally occur. They’ll use local anesthesia to numb your nose and throat, but you may experience a mild gagging sensation as the tube is placed. Over a period of an hour or two, the tube will suck out samples of the fluids released by your pancreas. These will be analyzed in a lab to check the bicarbonate levels. If your bicarbonate levels are low, your pancreatic function may be impaired.

Endoscopic ultrasound (EUS). An endoscopic ultrasound combines ultrasound technology with an upper endoscopy, a procedure that examines your upper GI tract. It uses an endoscope, a long, thin, flexible tube with a lighted scope at the end, along with a tiny ultrasound probe. During the test, the endoscope is passed down your throat and into your upper small intestine (duodenum). The ultrasound probe produces digital images of your organs on the way down. It takes about 15-45 minutes, and while most people consider it only a little uncomfortable, you may be sedated or even put to sleep if you’d like.

The endoscopic ultrasound provides highly detailed imaging of the entire upper GI tract. It can give your provider a more detailed look at your pancreas than the CT scan or MRCP. Your healthcare provider may recommend an EUS to further evaluate abnormal findings from a less invasive imaging test. Or they might recommend it instead of a CT or MRCP if those tests aren’t a good option for you — for example, if you’re claustrophobic or allergic to the contrast dye. EUS is considered a less invasive alternative to the endoscopic retrograde cholangiopancreatography (ERCP) scan, with similar results.

One of the chief advantages of the EUS is that the endoscope can also take a biopsy at the time of the exam. The scope allows a healthcare provider to guide fine needles into the tissues of the pancreas and extract samples for later analysis. (This is called fine-needle aspiration, or FNA.) For this reason, the EUS is often recommended to check out a suspected tumor or cyst. If the ultrasound finds one, an FNA biopsy can help determine whether it is malignant or benign, as well as other important characteristics.

Endoscopic retrograde cholangiopancreatography (ERCP): More rarely, some people might require an ERCP scan to be accurately diagnosed. Similar to the EUS, the ERCP also sends an endoscope down your throat and into your digestive tract. But instead of ultrasound, it uses X-ray technology to help visualize your pancreas and ducts. Specifically, it uses fluoroscopy — a type of video X-ray, which requires a contrast dye. Your provider will pass a smaller catheter through the endoscope catheter to deliver the contrast dye into your bile ducts, where it will travel to your pancreas. They’ll take X-rays as the dye travels.

This test may reveal lesions and obstructions in the pancreas and ducts that didn’t show up on other imaging tests. It's usually only used when a condition is already known or highly suspected but not yet proven, in order to recommend a specific intervention, such as surgery or a stent. Your healthcare provider may also remove a blockage or place a stent during the test, using small instruments passed through the endoscope. You’ll lie on your side and an IV in your arm will deliver fluids and sedatives. You’ll likely be drowsy but awake and experience only mild discomfort for about 30 to 90 minutes.

A note from Cleveland Clinic

Symptoms of abdominal distress and digestive problems can have many causes. Some are more serious than others. If you suspect there could be something wrong with your pancreas, it’s best to find out as soon as possible so you can get the care you need. Your healthcare provider will determine the best diagnostic tests to start with based on your health history, symptoms and risk factors. They’ll use the results to isolate the cause of your problems and recommend the best treatment plan.