A 54-Year-Old Woman Comes to the Physician Due to Worsening

A 54-year-old woman comes to the physician due to worsening epigastric pain over the last 2 months.  The pain, which is worse at night, was initially intermittent but is now somewhat constant and radiates to the back.  She has lost 6.8 kg (15 lb) over the past 3 months.  The patient reports no change in the color of stools or urine.  Two years ago, she was diagnosed with idiopathic chronic pancreatitis and started on pancreatic enzyme replacement therapy.  The patient initially had diarrhea, epigastric discomfort, and flatulence that improved with pancreatic enzymes.  She does not use tobacco, alcohol, or illicit drugs.  Vital signs are within normal limits.  Her BMI is 21 kg/m².  There is no jaundice.  Abdominal examination demonstrates mild epigastric tenderness on deep palpation.  Laboratory results are as follows: Which of the following is the most appropriate next step in management of this patient?

A) Cancer-associated antigen testing
B) CT scan of the abdomen with contrast
C) Endoscopic retrograde cholangiopancreatography
D) Intensification of pancreatic enzyme replacement therapy
E) Plain abdominal radiography
F) Reassurance and opioid therapy
G) Secretin pancreatic function testing