Background: Previous studies have shown the Endoscopic Ulstrasonongraphy (EUS) is
very sensitive for the detection of morphologic abnormailities due to chronic pancreatitis.
Unfortunately there are uncertainities about the specificity of EUS findings, particularly
in the early stages of chronic pancreatitis. Since the “gold standard” for the diagnosis
of chronic pancreatitis (tissue diagnosis) is lacking, one way to validate findings
is to do clinical follow up. Aim: Our aim is to understand if in a clinical context
suspect for chronic pancreatitis, patients who have a normal ERCP but an EUS that
shows features of chronic pancreatitis, will develop imagilogic or clinical characteristic
features of chronic pancreatitis, comfirming a higher sensitivity of EUS, or on the
other hand, if they have false positive EUS for chronic pancreatitis. Method: In a
retrospective review of the EUS database from a 4-year period (January of 1996 - Dec
1999), we found 240 patients less than 65 years old and clinical symptoms suggestive
of chronic pancreatitis that had both EUS and ERCP. Patients with malignancy were
excluded. Of these 240 patients, 48 (20%) had discrepancy between EUS and ERCP findings,
withy normal ERCP but EUS features of moderate/high probability for chronic pancreatitis
(>3 features on EUS). Chart review or contact by phone was used to document pancreatitis.
Patients were asked if they were diagnosed with pancreatitis. If they responded yes,
two questions were asked verbatim without coaxing. These questions included when the
diagnosis was made and how. Results: 48 Patients (Female 34; mean age 42 (range 19
- 62 years) were reviewed. The average follow-up time was 8.4 years (range 7 - 9.6
years). 29/48 (60%) patients were contacted or chart reviewed, 19 were lost to follow-up.
Of those suspected of having early chronic pancreatitis in which EUS was the only
abnormality, 55% progressed clincially such that the diagnosis could be established.
13/29 (45%) of the patients did not have a diagnosis of pancreatitis on follow-up.
Conclusion: EUS can be used in the preliminary diagnosis of pancreatitis. Before 2001
years ago, we use 3 or more criteria on EUS to diagnose chronic pancreatitis. We decided
based on histology and the fact that we would rather have a higher specificity rather
than sensitivity to label patients as “chronic pancreatitis”, we changed our criteria
from 3 or more to 5 or more. Thus, some of the 45% that did not evolve into clear
chronic pancreatitis may have been read as normal by todays criteria.
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© 2006 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.