EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification

Background

EUS is increasingly used in the diagnosis of chronic pancreatitis (CP). A number of publications in this field have used different EUS terminology, features, and criteria for CP, making it difficult to reproduce their findings and apply them in clinical practice. Moreover, traditional criteria such as the Cambridge classification for CP are arguably outdated and have lost their relevance.

Objective

Our purpose was to establish consensus-based criteria for EUS features of CP.

Design

Consensus study.

Main Outcome Measurements

Thirty-two internationally recognized endosonographers anonymously voted on terminology of EUS features, rank order, and category (major vs minor criteria). Consensus was defined as greater than two thirds agreement among participants.

Results

Major criteria for CP were (1) hyperechoic foci with shadowing and main pancreatic duct (PD) calculi and (2) lobularity with honeycombing. Minor criteria for CP were cysts, dilated ducts ≥3.5 mm, irregular PD contour, dilated side branches ≥1 mm, hyperechoic duct wall, strands, nonshadowing hyperechoic foci, and lobularity with noncontiguous lobules.

Limitation

Lack of broadly accepted reference standard.

Conclusion

In a complex disease such as CP that has no universally accepted reference standard, an EUS-based criterion for diagnosis can be determined by expert consensus opinion and the existing body of evidence. Here we present the new “Rosemont criteria” for the EUS diagnosis of CP.

Abbreviations: BMI, body mass index, CP, chronic pancreatitis, MPD, main pancreatic duct, MRI, magnetic resonance imaging, OR, odds ratio, PD, pancreatic duct, PFT, pulmonary function test, ROC, receiver-operating characteristic curve