A proposal of a diagnostic algorithm with validation of International Consensus Diagnostic Criteria for autoimmune pancreatitis in a Japanese cohort

Sumimoto, Kimi; Uchida, Kazushige; Mitsuyama, Toshiyuki; Fukui, Yoshihiro; Kusuda, Takeo; Miyoshi, Hideaki; Tomiyama, Takashi; Fukata, Norimasa; Koyabu, Masanori; Sakaguchi, Yutaku; Ikeura, Tsukasa; Shimatani, Masaaki; Fukui, Toshiro; Matsushita, Masayuki; Takaoka, Makoto; Nishio, Akiyoshi; Okazaki, Kazuichi

doi:10.1016/j.pan.2013.02.010

Cited by 37 publications

(26 citation statements)

References 70 publications

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“…This study confirms a previous smaller report that showed the sensitivities of 5 major criteria sets to be 95.1% (ICDC), 90.2% (Korean), 86.9% (JPS 2011), and 83.6% (Asian and HISORt) [17]. A high specificity for all systems was also noted [17].…”

Section: Discussionsupporting

confidence: 90%

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International Consensus Diagnostic Criteria for Autoimmune Pancreatitis and Its Japanese Amendment Have Improved Diagnostic Ability over Existing Criteria

Maruyama

Watanabe

Kanai

et al. 2013

Gastroenterology Research and Practice

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Objectives. The recent International Consensus Diagnostic Criteria (ICDC) for autoimmune pancreatitis (AIP) and its Japanese amendment developed by the Japanese Pancreas Society (JPS 2011) may have overcome the drawbacks of earlier criteria and achieved a higher diagnostic ability for AIP. The aim of the present study is to evaluate this possibility and identify the underlying causes of this change. Methods. We compared the diagnostic abilities of the ICDC and JPS 2011 with those of the Japanese diagnostic criteria 2006 (JPS 2006), Korean diagnostic criteria (Korean), Asian diagnostic criteria (Asian), and HISORt diagnostic criteria in 110 patients with AIP and 31 patients with malignant pancreatic cancer. Results. The ICDC achieved the highest diagnostic ability in terms of accuracy (95.0%), followed by JPS 2011 (92.9%), Korean (92.2%), HISORt (88.7%), Asian (87.2%), and JPS 2006 (85.1%). Nearly all criteria systems exhibited a high specificity of 100%, indicating that the enhanced diagnostic ability of the ICDC and JPS 2011 likely stemmed from increased sensitivity brought about by inclusion of diagnostic items requiring no endoscopic retrograde pancreatography. The diagnostic ability of JPS 2011 was nearly equivalent to that of the ICDC. Conclusions. The ICDC and JPS 2011 have improved diagnostic ability as compared with earlier criteria sets because of an increase in sensitivity.

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Section: Discussionsupporting

confidence: 90%

“…A high specificity for all systems was also noted [17]. With regard to AIP cases with focal or segmental pancreatic swelling, especially those difficult to discriminate from malignant pancreatic tumor [18–20], the diagnostic ability of JPS 2011 trailed that of the ICDC due to its requirement for ERP evaluation.…”

Section: Discussionmentioning

confidence: 99%

International Consensus Diagnostic Criteria for Autoimmune Pancreatitis and Its Japanese Amendment Have Improved Diagnostic Ability over Existing Criteria

Maruyama

Watanabe

Kanai

et al. 2013

Gastroenterology Research and Practice

View full text Add to dashboard Cite

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“…material), procedures were defined as required if diagnosis could not be established as definite by histology or imaging, which then required additional work-up to exclude pancreatic carcinoma. Imaging results were also labelled as 'diffuse', 'segmental/focal' or atypical [11] . If an ERCP was conducted for the removal of a stent or drainage placed during a previous endoscopic procedure, it was labelled as required if the first procedure had been indicated.…”

Section: Definition Of Required/unnecessary Proceduresmentioning

confidence: 99%

Unnecessary Procedures and Surgery in Autoimmune Pancreatitis

et al. 2015

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Background/Aims: To identify the number and potential causes of unnecessary diagnostic procedures in a cohort of patients with autoimmune pancreatitis (AIP). Methods: All AIP cases at our centre between April 2006 and April 2013 were collected and followed up. Diagnosis was established by the International Consensus Diagnostic Criteria (ICDC). Demographic, clinical, radiological, serological data, the number of diagnostic procedures and the reason for referral were recorded. Possible risk factors for a delayed diagnosis of AIP were analysed. Results: A total of 29 patients (median age 60 years; 22 males and 7 females) were diagnosed with AIP using ICDC. Twenty-five patients were diagnosed with definite, 2 with possible type 1 AIP and 2 with type 2 AIP. In 29 patients, 50 ERCPs and 18 EUS were carried out; based on ICDC recommendations, a total of 20 ERCPs and 4 EUS were unnecessary diagnostic procedures. Eight patients (23.0%) were referred for unnecessary surgery. Jaundice was shown to be a significant risk factor for unnecessary endoscopic investigations (OR 11.00, 95% CI 1.14-106.43, p = 0.04). Conclusion: Diagnosis of AIP still remains a challenge. Patients with jaundice are at particular risk of being subjected to unnecessary endoscopic procedures. Use of ICDC would help avoid unnecessary examinations or even major surgeries at times.

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“…The characteristically elevated serum IgG-4 levels along with the imaging features of a fi brotic capsule surrounding the "sausage- shaped" pancreas and compression of the pancreatic duct may not always be present. As such, when in doubt, endoscopic ultrasound (EUS) and EUS-guided needle biopsy should be attempted to improve specifi city of diagnosis (Sumimoto et al 2013 ) (Fig. 15.36 ).…”

Section: Pancreasmentioning

confidence: 99%