Significance of Normal Appearance on Endoscopic Ultrasonography in the Diagnosis of Early Chronic Pancreatitis

Overview

Journal Endosc Ultrasound

Date 2017 Jul 8

PMID 28685746

Citations 7

Authors

Ai Sato

Atsushi Irisawa

Manoop S Bhutani

Goro Shibukawa

Akane Yamabe

Mariko Fujisawa

Ryo Igarashi

Noriyuki Arakawa

Yoshitsugu Yoshida

Yoko Abe

Takumi Maki

Koki Hoshi

Hiromasa Ohira

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: The Rosemont classification (RC) was developed as a consensus-based standard for the diagnosis of chronic pancreatitis (CP) by endoscopic ultrasonography (EUS), however, it is more complicated than the conventional scoring system. We have noticed that in the early stages of CP, it is not unusual to observe pancreas with abnormal appearance coexisting with the areas of normal parenchyma. The aim of this study was to investigate the validity of a "normal" pancreas appearance and to evaluate the usefulness of modified diagnostic criteria in comparison to the traditional EUS criteria and the RC.

Patients And Methods: One hundred and seventy-seven patients who had undergone both EUS and endoscopic retrograde pancreatography (ERP) within 2 months were enrolled in the study, and patients with pancreatic cancer were excluded from the study. ERP findings were used as the gold standard for the diagnosis of CP. The EUS images obtained were classified according to both the RC and our new modified criteria. The latter includes an additional criterion to the modified traditional criteria: fine-reticular pattern (F-RP) was defined as a normal pancreatic parenchyma. We compared the accuracy between the new modified EUS criteria and the RC.

Results: (1) Normal or equivocal findings on ERP were obtained for 132 patients; 113 patients had F-RP on EUS. In contrast, F-RP was found in only 6 out of 45 CP cases on ERP (P < 0.0001). (2) We investigated the diagnostic capability of our new criteria for endoscopic retrograde cholangiopancreatography normal/equivocal pancreas compared to the traditional criteria. In cases where fewer than two points were defined as normal, the incidence of normal pancreas was significantly higher based on the new criteria than on the traditional criteria (P = 0.002). (3) No significant differences were found between the new criteria and the RC across all ERP grades.

Conclusion: Our new proposed "normal-added EUS criteria" for diagnosing CP was equivalent to the RC.

Citing Articles

Diagnosing chronic pancreatitis by endoscopic ultrasound assessing the association between ultrasound and pathological findings: A narrative review.

Yamamiya A, Irisawa A, Abe Y, Arisaka T, Ohnishi T, Hoshi K DEN Open. 2022; 3(1):e164.

PMID: 36176351 PMC: 9478231. DOI: 10.1002/deo2.164.

Pancreatic Fibrosis (Early Chronic Pancreatitis) as Emerging Diagnosis in Structural Causes of Dyspepsia: Evidence from Endoscopic Ultrasonography and Shear Wave Elastography.

Huang C, Lee T, Lin C, Chen C, Yang Y, Liang Y Diagnostics (Basel). 2021; 11(7).

PMID: 34359334 PMC: 8304562. DOI: 10.3390/diagnostics11071252.

Interobserver Reliability of the Endoscopic Ultrasound Criteria for the Diagnosis of Early Chronic Pancreatitis: Comparison between the 2009 and 2019 Japanese Diagnostic Criteria.

Yamamiya A, Irisawa A, Tominaga K, Tsuchida K, Sugaya T, Tsunemi M Diagnostics (Basel). 2021; 11(3).

PMID: 33802623 PMC: 8000630. DOI: 10.3390/diagnostics11030431.

Endoscopic Ultrasonography Findings of Early and Suspected Early Chronic Pancreatitis.

Takasaki Y, Ishii S, Fujisawa T, Ushio M, Takahashi S, Yamagata W Diagnostics (Basel). 2020; 10(12).

PMID: 33261170 PMC: 7760161. DOI: 10.3390/diagnostics10121018.

Endoscopic ultrasonography elastography in the diagnosis of intrapancreatic ectopic spleen: A case report.

Ge N, Sun S World J Clin Cases. 2020; 8(9):1729-1734.

PMID: 32420307 PMC: 7211534. DOI: 10.12998/wjcc.v8.i9.1729.

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