Prospective Evaluation Of Endoscopic Ultrasonography And Endoscopic Retrograde Cholangiopancreatography In The Diagnosis Of Chronic Pancreatitis In An Adolescent Population.

Chronic pancreatitis (CP) in its early stages may defy diagnosis despite existing diagnostic modalities. Endoscopic retrograde cholangiopancreatography, Secretin test, conventional ultrasound, and computed tomography are insensitive in detecting the early stages of CP. AIM: To determine if EUS high resolution imaging allows for the detection of CP when compared to clinical history, ERCP, and Secretin test. METHOD: Thirty-two consecutive patients (22-w, 10-m, age range 13-19, mean 16.6) over a seven year period with acute or recurrent pancreatitis underwent ERCP. ERCP evaluation of chronic pancreatitis was determined by the Cambridge Classification. EUS evaluated: 1. Parenchymal changes: echogenic foci (calcifications), prominent interlobular septae (fibrosis), atrophy, heterogeneous parenchyma, lobular gland margin, microcystic lesions; and 2. Ductal changes: Dilation, stricture, irregularity, echogenic wall (fibrosis), side branch ectasia, echogenic foci (stone). EUS criteria for CP included: mild (1-2 features), moderate (3-5 features present), severe (>than 5 features). RESULTS: Abnormal studies were seen by EUS=26 and ERCP=18. Agreement between EUS specific criteria and ERCP was excellent for normal (83%), moderate (89%),and severe (100%) CP but poor for mild disease by EUS criteria (33.3%). CONCLUSION: Using the above EUS criteria, EUS may assist in the diagnosis of CP not established by clinical history or ERCP. Excellent agreement can be expected between EUS and ERCP diagnosis of CP with the exception of mild changes noted on EUS. Longterm follow-up of CP patients with mild EUS changes will determine the validity of EUS in diagnosing the early changes of CP. Chronic pancreatitis (CP) in its early stages may defy diagnosis despite existing diagnostic modalities. Endoscopic retrograde cholangiopancreatography, Secretin test, conventional ultrasound, and computed tomography are insensitive in detecting the early stages of CP. AIM: To determine if EUS high resolution imaging allows for the detection of CP when compared to clinical history, ERCP, and Secretin test. METHOD: Thirty-two consecutive patients (22-w, 10-m, age range 13-19, mean 16.6) over a seven year period with acute or recurrent pancreatitis underwent ERCP. ERCP evaluation of chronic pancreatitis was determined by the Cambridge Classification. EUS evaluated: 1. Parenchymal changes: echogenic foci (calcifications), prominent interlobular septae (fibrosis), atrophy, heterogeneous parenchyma, lobular gland margin, microcystic lesions; and 2. Ductal changes: Dilation, stricture, irregularity, echogenic wall (fibrosis), side branch ectasia, echogenic foci (stone). EUS criteria for CP included: mild (1-2 features), moderate (3-5 features present), severe (>than 5 features). RESULTS: Abnormal studies were seen by EUS=26 and ERCP=18. Agreement between EUS specific criteria and ERCP was excellent for normal (83%), moderate (89%),and severe (100%) CP but poor for mild disease by EUS criteria (33.3%). CONCLUSION: Using the above EUS criteria, EUS may assist in the diagnosis of CP not established by clinical history or ERCP. Excellent agreement can be expected between EUS and ERCP diagnosis of CP with the exception of mild changes noted on EUS. Longterm follow-up of CP patients with mild EUS changes will determine the validity of EUS in diagnosing the early changes of CP.