Prospective evaluation of endoscopic ultrasonography, endoscopic retrograde pancreatography, and secretin test in the diagnosis of chronic pancreatitis

Evidence-based clinical practice guidelines for chronic pancreatitis 2015

“…This chapter describes how chronic pancreatitis is suspected, based on signs, symptoms, and laboratory results, and how the diagnosis is developed. The CQ are very detailed and consist of 12 items, including history taking, physical examination, determination methods for pancreatic enzymes in the blood and urine [5,6], significance of various imaging methods [chest and abdominal radiography, abdominal ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound, and pancreatography] in the diagnosis of chronic pancreatitis [7][8][9][10][11][12][13][14][15], exocrine pancreatic function testing, pathological diagnosis, differential diagnosis from pancreatic cancer and intraductal papillary mucinous neoplasm (IPMN), and genetic testing [16][17][18][19][20].…”

Endosonographic Diagnosis of Chronic Pancreatitis

“…In addition, the EUS is able to evaluate the severity of CP depending on the number of criteria present with high sensitivity and specificity. The disease severity was classified as mild (2 or 3-4 features), moderate (5-6 features), and severe (more than 7 features), based on ERP findings as a gold standard [8][9][10].…”

“…The characteristic imaging findings for early CP were set as the following seven EUS features (five parenchymal and two ductal features): (1) lobularity with honeycombing, (2) lobularity without honeycombing, (3) hyperechoic foci without shadowing, (4) stranding, (5) cysts, (6) dilated side branches, and (7) hyperechoic main pancreatic duct (MPD) margin [15] (Table 3). More than two among the seven features including any of (1)-(4), which are most likely to reflect fibrous changes in pancreatic parenchyma, are judged to be sufficient for the EUS findings of early CP [9][10][11][12]20,21]. It remains as a challenge for future study to ascertain whether early CP diagnosed using these criteria progress to advanced CP.…”

“…Previous reports suggest that EUS can be a sensitive modality for diagnosing chronic pancreatitis when compared to ERCP findings [7,9,10,12,25]. However, currently inter observer variation might affect EUS diagnosis of chronic pancreatitis.…”

“…Endoscopic ultrasonography (EUS) is a well-established and less-invasive modality for CP diagnosis [5][6][7][8][9][10]. Although endoscopic retrograde pancreatigraphy (ERP) has been regarded as the gold standard for CP diagnosis, ERP cannot investigate the parenchymal changes.…”