Endoscopic ultrasonography and endoscopic retrograde pancreatography in the diagnosis of chronic pancreatitis

Abstract

Background: The diagnosis of chronic pancreatitis (CP) in the early stages is often problematic. Endoscopic retrograde pancreatography (ERP), secretin test and computed tomography are not sensitive enough to detect the early stages of CP. The aim of this study was to investigate the features of CP in endoscopic ultrasonography (EUS) in patients with unexplained abdominal pain and/or suspected CP. Methods: Thirty‐four consecutive patients in whom CP was suspected after reviewing their history, abdominal ultrasonography and upper gastrointestinal endoscopy findings underwent EUS. Endoscopic ultrasonography was performed by an author who was aware of the history but blinded to the ERP results. Nineteen patients underwent ERP. Endoscopic ultrasonography was used to evaluate parenchymal changes (echogenic foci, echo pattern, prominent interlobular septa, lobularity, cyst and cavities) and ductal changes (dilatation, echogenicity of duct wall, irregularity, side branch ectasia, tortuousity). Results: Nine patients were found to be normal with regard to EUS examination. Abnormal studies for EUS were 25, while for ERP they were 17. The agreement between ERP and EUS was 100% in the 14 patients with moderate and severe disease. The diagnosis of early or mild CP was established with EUS in 11 patients. Endoscopic retrograde pancreatography, which was performed in five of the patient groups with mild disease, was normal in two patients and showed mild changes in three patients. Conclusions: Endoscopic ultrasonography may contribute to establishing the diagnosis and severity of CP found by ERP. Prospective randomized studies and long‐term follow up of patients are needed in order to determine the role of EUS in the diagnosis of early CP.