Prospective assessment of the ability of endoscopic ultrasound to diagnose, exclude, or establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography,☆☆,,★★

Presented in oral form at Digestive Disease Week 1997, May 11-14, 1997, Washington, DC.
https://doi.org/10.1016/S0016-5107(98)70123-3Get rights and content

Abstract

Background: Our aim was to verify endoscopic ultrasound (EUS) accuracy to diagnose, rule out, and establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography (ERCP). Methods: Patients undergoing ERCP for unexplained abdominal pain and/or suspected chronic pancreatitis underwent EUS. EUS was performed by experienced operators who were aware of the history but blinded to ERCP results. Chronic pancreatitis was defined using the Cambridge classification: 0 to 1 = “normal,” 2 to 4 = “all chronic pancreatitis,” 3 to 4 = “moderate to severe chronic pancreatitis.” The number of EUS criteria required to obtain sensitivity, specificity, positive and negative predictive values ≥ 85% was determined. EUS criteria for chronic pancreatitis are hyperechoic foci, hyperechoic strands, lobularity, hyperechoic duct, irregular duct, visible side-branches, ductal dilation, calcification, and cysts. Results: One hundred twenty-six patients underwent EUS and ERCP. EUS was highly sensitive and specific (> 85%) depending on the number of criteria present. Chronic pancreatitis is likely (PPV > 85%) when more than two criteria (for “all chronic pancreatitis”) and more than six criteria (for “moderate to severe chronic pancreatitis”) are present. “Moderate to severe chronic pancreatitis” is unlikely (NPV > 85%) when fewer than three criteria are present. Independent predictors of chronic pancreatitis were “calcification” (p = 0.000001), history of alcohol abuse (p = 0.002), and the total number of EUS criteria (p = 0.008). Conclusions: EUS can accurately diagnose, rule out, and establish the severity of chronic pancreatitis found by ERCP. (Gastrointest Endosc 1998;48:18-25.)

Section snippets

Patients and Methods

Our digestive disease center is a tertiary referral center for pancreatic and biliary disease, with expertise in sphincter of Oddi manometry and EUS. From February 1996 to March 1997, patients referred for ERCP for unexplained abdominal pain and/or suspected CP routinely underwent EUS before ERCP. The following information was collected: age, gender, body mass index (BMI), and presence or absence of alcohol abuse (defined as more than 10 drinks per week).

EUS was performed by experienced

Results

One hundred twenty-six patients underwent both EUS and ERCP. Patient characteristics, final ERCP-based diagnoses, and the frequency of EUS criteria for CP are shown in Table 2.

. Demographics, ERCP-based diagnosis, and frequency of EUS criteria for patients as a function of Cambridge score

Empty CellCambridge class
0 n = 20 (15.5)1 n = 10 (7.9)2 n = 37 (29.4)3 n = 32 (25.4)4 n = 27 (21.4)Total n = 126 (100)
Demographics
 Mean age (yr)48.440.944.147.349.547.1
 Male sex6 (27.2)4 (40.0)13 (35.1)15 (46.9)17 (63.0)55

Discussion

To determine the ability of EUS to accurately diagnose and establish the severity of CP, the use of an appropriate “gold standard” is crucial. Unfortunately, it is impractical to obtain pancreatic biopsy specimens safely, and there is no well-established histologic classification scheme for CP. Although some argue that secretin-stimulated duodenal bicarbonate secretion is the true gold standard for CP (in the absence of pathology),5 others may argue that it is difficult to standardize and

Acknowledgements

We thank Patrick Mauldin, PhD, for carrying out the univariate and multivariate analyses.

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  • Cited by (0)

    From the Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina

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    Dr. Sahai was funded by an ASGE/Olympus Advanced Endoscopic Training Scholarship from July 1996 to June 1997 and is currently funded by an ADHF Outcomes Training Award July 1997.

    Reprint requests: Anand Sahai, MD, FRCP, Digestive Disease Center, MUSC, Suite 421, North Tower, 171 Ashley Ave., Charleston, SC 29425-2220.

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