The modified dual-label Schilling test, as further developed in kit form by Amersham International plc (UK), has been assessed in two separate centres. Since the outcome was similar in each centre, the results in 66 subjects were amalgamated. Using a cut-off point for the 58Co/57Co ratio of 0.52--as derived from studies in 10 healthy volunteers--to separate normal from abnormal results, the specificity of the test was 88%. However, the test's sensitivity in chronic pancreatic disease was only 50%: normal results occurred in 5 of 8 patients with pancreatic cancer (including 2 with steatorrhoea), and 9 of 21 with chronic pancreatitis (including 1 with steatorrhoea). The possible reasons for the test's poor sensitivity are discussed.
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