Endoscopic ultrasonography is the method of choice for detection of morphologic changes related to chronic pancreatitis. There are criteria, in the literature, that evaluate morphologic changes by endoscopic ultrasonography suggestive of chronic pancreatitis. The most widely used are the Rosemont criteria. Currently, the most effective diagnostic methods for exocrine pancreatic insufficiency are fat quantification (disused) and the 13C-mixed triglyceride breath test, not available in our country. However, the probability of diagnosis of pancreatic insufficiency can be estimated over the base of symptoms, malnutrition parameters, faecal elastase and signs of chronic pancreatitis in images. The aim of this study was to determine the correlation, probability and severity of exocrine pancreatic insufficiency, according to Rosemont criteria, in patients with chronic pancreatitis. A retrospective descriptive study was performed. Data were collected from patients between April of 2017 and April of 2018. The data gathered was based on pancreatic morphologic characteristics according to Rosemont criteria and related to the diagnosis of exocrine pancreatic insufficiency diagnosis based on the levels of stool elastase. Twenty one patients with chronic pancreatitis were included. The presence of hyperechogenic foci > 2 mm with posterior acoustic shadowing was associated with the presence of severe exocrine pancreatic insufficiency (p < 0.001). In our study, the association between parenchymal morphologic findings of chronic pancreatitis was significant in predicting exocrine pancreatic insufficiency. The role of endoscopic ultrasonography in predicting functional compromise in patients with chronic pancreatitis is promising.

Endoscopic submucosal dissection is a complex technique that allows en bloc resection of large lesions. It is associated with long-term, technically complex procedures and a high risk of complications. The creation of a submucosal pocket is a variant of the conventional technique that reduces these difficulties, generating a high rate of complete resection with a shorter procedure time, a faster dissection speed and a lower rate of adverse events. Even though this variant was initially described in the stomach, its application has been generalized to other areas of the digestive tract. We present two cases where this variant technique was applied to treat large early lesions, with technical success.