5.6　Summary

In order to minimize the overall cost and risk，diagnostic ERCP is generally considered a second-echelon method to be employed when none of those noninvasive or low-risk tests establishes the diagnosis；besides，the importance of ERCP is further reduced since direct pancreatic function testing（such as hormonal stimulation tests in particular），a valuable complement to the diagnostic algorithm，offers the most sensitivity and allows the identification of earlier or less advanced CP（Forsmark 2000，2008；Forsmark and Toskes 1995；Ketwaroo et al.2013；Parsi et al.2008）.However，the test is now only available in a few centers and neither standardized procedures nor normal ranges have been developed between those centers，hampering the wide availability of this promising approach（Forsmark 2000，2008；Ketwaroo et al.2013）.Actually，ERCP is clearly used more frequently in the clinical practice given the condition that it would effectively make a differential diagnosis，accurately evaluate and classify the severity and distribution of ductal changes，and even efficiently treat the disease at the same time，despite the relatively high cost and risk.(https://www.daowen.com)

The current paradox of the utility of diagnostic ERCP has stimulated the search for new and hopefully better diagnostic approaches in the future.For example，in addition to conventional endoscopic-based pancreatic function testing，the intraductal secretin stimulation test would collect pancreatic juice directly from the pancreatic duct at the time of ERCP after the administration of secretin alone or followed by cholecystokinin（Conwell et al.2014；Lieb and Draganov 2008；Paulo et al.2011；Sze et al.2014）.As a combination of both morphological and functional tests，this method seems to satisfy the need for the future diagnosis of CP.