RT Journal Article
SR Electronic
T1 Endoscopic retrograde pancreatography criteria to diagnose autoimmune pancreatitis: an international multicentre study
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 666
OP 670
DO 10.1136/gut.2010.207951
VO 60
IS 5
A1 Aravind Sugumar
A1 Michael J Levy
A1 Terumi Kamisawa
A1 George J M Webster
A1 Myung-Hwan Kim
A1 Felicity Enders
A1 Zahir Amin
A1 Todd H Baron
A1 Mike H Chapman
A1 Nicholas I Church
A1 Jonathan E Clain
A1 Naoto Egawa
A1 Gavin J Johnson
A1 Kazuichi Okazaki
A1 Randall K Pearson
A1 Stephen P Pereira
A1 Bret T Petersen
A1 Samantha Read
A1 Raghuwansh P Sah
A1 Neomal S Sandanayake
A1 Naoki Takahashi
A1 Mark D Topazian
A1 Kazushige Uchida
A1 Santhi Swaroop Vege
A1 Suresh T Chari
YR 2011
UL http://gut.bmj.com/content/60/5/666.abstract
AB Background Characteristic pancreatic duct changes on endoscopic retrograde pancreatography (ERP) have been described in autoimmune pancreatitis (AIP). The performance characteristics of ERP to diagnose AIP were determined.Methods The study was done in two phases. In phase I, 21 physicians from four centres in Asia, Europe and the USA, unaware of the clinical data or diagnoses, reviewed 40 preselected ERPs of patients with AIP (n=20), chronic pancreatitis (n=10) and pancreatic cancer (n=10). Physicians noted the presence or absence of key pancreatographic features and ranked the diagnostic possibilities. For phase II, a teaching module was created based on features found most useful in the diagnosis of AIP by the four best performing physicians in phase I. After a washout period of 3 months, all physicians reviewed the teaching module and reanalysed the same set of ERPs, unaware of their performance in phase I.Results In phase I the sensitivity, specificity and interobserver agreement of ERP alone to diagnose AIP were 44, 92 and 0.23, respectively. The four key features of AIP identified in phase I were (i) long (>1/3 the length of the pancreatic duct) stricture; (ii) lack of upstream dilatation from the stricture (<5 mm); (iii) multiple strictures; and (iv) side branches arising from a strictured segment. In phase II the sensitivity (71%) of ERP significantly improved (p<0.05) without a significant decline in specificity (83%) (p>0.05); the interobserver agreement was fair (0.40).Conclusions The ability to diagnose AIP based on ERP features alone is limited but can be improved with knowledge of some key features.