what is the most accurate test for chronic pancreatitis?

In my preparation for step II I have seen different answers.

I've seen three answers in three different questions in Kaplan Qbank and UWorld Qbank

stool elastase
secretin test checking for bicarb release
and ERCP

which one is the single most accurate test for chronic pancreatitis??


thank you so much

Chronic pancreatitis is a difficult diagnosis. Of those tests, secretin stim is the most sensitive but is exceedingly impractical. ERCP for CP has gone the way of the Dodo bird, replaced by EUS. EUS is quite specific but not very sensitive for early CP. Not many centers do fecal elastase either. Don't sweat this one, these are bad questions since the experts disagree (for example, there are 9 EUS criteria and there is great debate how many you need to see to make the dx (ranging from 3 to 6).