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

A. V. Sahai, M. Zimmerman, L. Aabakken, P. R. Tarnasky, J. T. Cunningham, A. Van Velse, R. H. Hawes, B. J. Hoffman

Research output: Contribution to journalArticlepeer-review

262 Scopus citations

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 sidebranches, 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.

Original languageEnglish (US)
Pages (from-to)18-25
Number of pages8
JournalGastrointestinal endoscopy
Volume48
Issue number1
DOIs
StatePublished - Jan 1 1998

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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