Su1419 The Evaluation of Rosemont Classification for EUS Diagnosis of Chronic Pancreatitis; Comparative Study Between the Rosemont Classification and the Traditional Criteria

BackgroundThe clinical course of chronic pancreatitis (CP)leads to a high rate of morbidity and mortality. Therefore, it's important to diagnose it at its early stage and for optimal management. Endoscopic ultrasound (EUS) provides excellent detail of parenchyma and duct which are not detectable by other imaging modalities. Although EUS criteria for CP has been proposed by some investigators (conventional criteria based on the number of EUS findings), recently, Rosemont consensus meeting proposed the new EUS diagnostic criteria in consideration of value of each EUS finding to make a consensus of EUS diagnosis of CP (Rosemont classification). The aim of this study is to evaluate and verify the significance of the Rosemont classification by comparative study between traditional criteria and new criteria.MethodsFifty patients who were presented two or more of the following features on EUS images (hyperechoic foci, hyperechoic strands, lobularity, cyst, Irregular duct contour, visible side branches, hyperechoic ductal margin,dilated main duct, and stone) during Jan. 2007-Dec.2009 were enrolled in this study. Each patient was diagnosed using traditional EUS criteria and Rosemont classification. The average age 62.5+/−12.5, and a ratio of male to female 43:7. Using traditional criteria, the patients divided into 3 groups, moderate-severe (more than 4 findings), mild (3-4 findings) and normal (less than 3 findings). On the other hand, using the Rosemont classification, the patients divided consistent with CP, suggestive of CP, indeterminate for CP, and normal.Results33 cases classified into Mild by the traditional criteria were reclassified as 11 cases in Normal, 20 cases in Indeterminate for CP, 1 case in Suggestive of CP and 1 case in Consistent with CP. Nine cases cllasified by traditional criteria were reclassified as 2 cases in Indeterminate for CP, 5 cases in Suggestive of CP and 2 cases in Consistent with CP. A diagnostic rate of the normal cases was 38% (19/50)and definitive CP was 6% (3/50) by the Rosemont classification. On the other, using traditional criteria, normal was 16% (8/50) and 18% (9/50), respectively. Moreover, using the traditional criteria, 100% cases (50/50) of hyperechoic foci and 94% cases (47/50) of hyperechoic strands have been identified as findings., however, the diagnostic rate of these findings was low, 80% (40/50) and 82% (41/50) in the Rosemont classification.ConclusionIt is considered that The Rosemont classification might be dropped the rate of picking-up the early stage of chronic pancreatitis. However, the patients who were classified into Mild group in traditional criteria were reclassified several different groups, these results may suggest the significance of the Rosemont classification. BackgroundThe clinical course of chronic pancreatitis (CP)leads to a high rate of morbidity and mortality. Therefore, it's important to diagnose it at its early stage and for optimal management. Endoscopic ultrasound (EUS) provides excellent detail of parenchyma and duct which are not detectable by other imaging modalities. Although EUS criteria for CP has been proposed by some investigators (conventional criteria based on the number of EUS findings), recently, Rosemont consensus meeting proposed the new EUS diagnostic criteria in consideration of value of each EUS finding to make a consensus of EUS diagnosis of CP (Rosemont classification). The aim of this study is to evaluate and verify the significance of the Rosemont classification by comparative study between traditional criteria and new criteria. The clinical course of chronic pancreatitis (CP)leads to a high rate of morbidity and mortality. Therefore, it's important to diagnose it at its early stage and for optimal management. Endoscopic ultrasound (EUS) provides excellent detail of parenchyma and duct which are not detectable by other imaging modalities. Although EUS criteria for CP has been proposed by some investigators (conventional criteria based on the number of EUS findings), recently, Rosemont consensus meeting proposed the new EUS diagnostic criteria in consideration of value of each EUS finding to make a consensus of EUS diagnosis of CP (Rosemont classification). The aim of this study is to evaluate and verify the significance of the Rosemont classification by comparative study between traditional criteria and new criteria. MethodsFifty patients who were presented two or more of the following features on EUS images (hyperechoic foci, hyperechoic strands, lobularity, cyst, Irregular duct contour, visible side branches, hyperechoic ductal margin,dilated main duct, and stone) during Jan. 2007-Dec.2009 were enrolled in this study. Each patient was diagnosed using traditional EUS criteria and Rosemont classification. The average age 62.5+/−12.5, and a ratio of male to female 43:7. Using traditional criteria, the patients divided into 3 groups, moderate-severe (more than 4 findings), mild (3-4 findings) and normal (less than 3 findings). On the other hand, using the Rosemont classification, the patients divided consistent with CP, suggestive of CP, indeterminate for CP, and normal. Fifty patients who were presented two or more of the following features on EUS images (hyperechoic foci, hyperechoic strands, lobularity, cyst, Irregular duct contour, visible side branches, hyperechoic ductal margin,dilated main duct, and stone) during Jan. 2007-Dec.2009 were enrolled in this study. Each patient was diagnosed using traditional EUS criteria and Rosemont classification. The average age 62.5+/−12.5, and a ratio of male to female 43:7. Using traditional criteria, the patients divided into 3 groups, moderate-severe (more than 4 findings), mild (3-4 findings) and normal (less than 3 findings). On the other hand, using the Rosemont classification, the patients divided consistent with CP, suggestive of CP, indeterminate for CP, and normal. Results33 cases classified into Mild by the traditional criteria were reclassified as 11 cases in Normal, 20 cases in Indeterminate for CP, 1 case in Suggestive of CP and 1 case in Consistent with CP. Nine cases cllasified by traditional criteria were reclassified as 2 cases in Indeterminate for CP, 5 cases in Suggestive of CP and 2 cases in Consistent with CP. A diagnostic rate of the normal cases was 38% (19/50)and definitive CP was 6% (3/50) by the Rosemont classification. On the other, using traditional criteria, normal was 16% (8/50) and 18% (9/50), respectively. Moreover, using the traditional criteria, 100% cases (50/50) of hyperechoic foci and 94% cases (47/50) of hyperechoic strands have been identified as findings., however, the diagnostic rate of these findings was low, 80% (40/50) and 82% (41/50) in the Rosemont classification. 33 cases classified into Mild by the traditional criteria were reclassified as 11 cases in Normal, 20 cases in Indeterminate for CP, 1 case in Suggestive of CP and 1 case in Consistent with CP. Nine cases cllasified by traditional criteria were reclassified as 2 cases in Indeterminate for CP, 5 cases in Suggestive of CP and 2 cases in Consistent with CP. A diagnostic rate of the normal cases was 38% (19/50)and definitive CP was 6% (3/50) by the Rosemont classification. On the other, using traditional criteria, normal was 16% (8/50) and 18% (9/50), respectively. Moreover, using the traditional criteria, 100% cases (50/50) of hyperechoic foci and 94% cases (47/50) of hyperechoic strands have been identified as findings., however, the diagnostic rate of these findings was low, 80% (40/50) and 82% (41/50) in the Rosemont classification. ConclusionIt is considered that The Rosemont classification might be dropped the rate of picking-up the early stage of chronic pancreatitis. However, the patients who were classified into Mild group in traditional criteria were reclassified several different groups, these results may suggest the significance of the Rosemont classification. It is considered that The Rosemont classification might be dropped the rate of picking-up the early stage of chronic pancreatitis. However, the patients who were classified into Mild group in traditional criteria were reclassified several different groups, these results may suggest the significance of the Rosemont classification.