Endoscopic retrograde pancreatography criteria to diagnose autoimmune pancreatitis: an international multicentre study

Sugumar, Aravind; Levy, Michael J.; Kamisawa, Terumi; Webster, George; Kim, Myung Hwan; Enders, Felicity; Amin, Zahir; Baron, Todd H.; Chapman, Mike; Church, Nicholas I.; Clain, Jonathan E.; Egawa, Naoto; Johnson, Gavin; Okazaki, Kazuichi; Pearson, Randall K.; Pereira, Stephen P.; Petersen, Bret T.; Read, Samantha; Sah, Raghuwansh P.; Sandanayake, Neomal S.; Takahashi, Naoki; Topazian, Mark D.; Uchida, Kazushige; Vege, Santhi Swaroop; Chari, Suresh T.

doi:10.1136/gut.2010.207951

Cited by 132 publications

(75 citation statements)

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“…An international multicenter study on ERP of AIP has identifi ed 4 specifi c ERP features of AIP being useful in the differential diagnosis between AIP and pancreatic cancer: (1) a long (>1/3 the length of the pancreatic duct) stricture, (2) lack of upstream dilatation from the stricture (>5 mm) ( Fig. 12.2 ), (3) multiple strictures, and (4) side branches arising from the stricture site [ 3 ]. Interestingly, the ability to diagnose AIP based on ERP features alone could be improved by awareness of these key features.…”

Section: Ercp Endoscopic Retrograde Pancreatographymentioning

confidence: 99%

Endoscopy: ERCP and EUS

Song

Kim

2014

Autoimmune Pancreatitis

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Section: Ercp Endoscopic Retrograde Pancreatographymentioning

confidence: 99%

Endoscopy: ERCP and EUS

Song

Kim

2014

Autoimmune Pancreatitis

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“…Images may show a long, narrow ductal stricture (>1/3 of the main pancreatic duct) with side branches extending from the stricture, or multiple non-continuous strictures [36].…”

Section: Endoscopic Retrograde Cholangiopancreatography (Ercp) and Enmentioning

confidence: 99%

Autoimmune pancreatitis: current concepts

Wang

Zhang

2013

Sci. China Life Sci.

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Autoimmune pancreatitis (AIP) is a distinct type of chronic pancreatitis with unique clinical, pathological, serological, and imaging features. AIP usually presents with obstructive jaundice. Imaging studies often reveal enlargement of the pancreas with a pancreatic mass and strictures of the main pancreatic duct. Two subtypes of AIP have recently been identified. Type I AIP is more prevalent in elderly Asian males and is characterized by lymphoplasmacytic sclerosing pancreatitis, obliterative phlebitis, and infiltration of large numbers of IgG4-positive plasma cells. Type II AIP is more prevalent in Caucasians and is characterized by granulocyte epithelial lesions. Most patients with type I AIP have a significantly elevated serum IgG4 concentration, which is an important feature for diagnosis and for differentiating between AIP and other conditions such as pancreatic cancer. Extrapancreatic complications are common, such as sclerosing cholangitis, sclerosing sialadenitis, retroperitoneal fibrosis in type I AIP, and ulcerative colitis in type II AIP. A rapid response to glucocorticoids treatment is suggestive of AIP, but the relapse rate is high, warranting the use of immunosuppressant treatment. B-cell depletion with rituximab may be a promising therapy. The prognosis of AIP is generally benign if treated promptly, and spontaneous remission occurs in a proportion of patients. autoimmune pancreatitis, IgG4, pancreatic cancer, glucocorticoids Citation:

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“…1). A thin, diffusely strictured main pancreatic duct may be seen [19]. Focal pancreatic masses may sometimes be seen.…”

Section: Making the Diagnosismentioning

confidence: 99%

Autoimmune Pancreatitis - A Riddle Wrapped in an Enigma

Webster¹

2016

Dig Dis

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Autoimmune pancreatitis (AIP) was recognized as a clinical entity, at least in the West little more than 10 years ago. Since then, studies globally, and international collaboration, have led to important advances in our understanding of its clinical features, disease course, and management, although the aetiopathogenesis of this curious disease remains to be fully elucidated. Types 1 and 2 AIP have been described, of which type 1 is the commonest form, and best defined. International consensus now recognizes it as one of the many clinical manifestations of IgG4-related disease, and is now termed IgG4-related pancreatitis (IgG4-RP). The disease is not confined to a particular race, gender, or age, but often presents after the fifth decade in men. A common presentation is with jaundice due to low bile duct obstruction related to diffuse pancreatic enlargement (historically often leading to a misdiagnosis of cancer). Acute pancreatitis is unusual. Other organ involvement is a particular feature, including biliary disease, retroperitoneal fibrosis, generalized lymphadenopathy, renal, and lung involvement. No single test makes the diagnosis, and diagnostic criteria for type 1 AIP/IgG4-RP, which incorporate clinical, laboratory, radiological, pathological, and therapeutic parameters should be applied. A particular attempt should be made to make a histological diagnosis, which is characterized by an IgG4-positive lymphoplasmacytic infiltrate. Management is not based on randomized studies, but corticosteroids are the mainstay of treatment, providing rapid clinical and radiological benefit. However, clinical relapse is common (particularly in type 1 AIP, and in those with associated other organ involvement). Additional immunosuppression may be required, including azathioprine, and rituximab may play an emerging role. The disease course is variable, but loss of organ function (especially pancreatic exocrine failure and pancreatic atrophy) may occur.

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Endoscopic retrograde pancreatography criteria to diagnose autoimmune pancreatitis: an international multicentre study

Abstract: The ability to diagnose AIP based on ERP features alone is limited but can be improved with knowledge of some key features.

Cited by 132 publications

References 18 publications

Endoscopy: ERCP and EUS

Endoscopy: ERCP and EUS

Autoimmune pancreatitis: current concepts

Autoimmune Pancreatitis - A Riddle Wrapped in an Enigma

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