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Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound for diagnosis of chronic pancreatitis

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Abstract

The diagnosis of chronic pancreatitis is based on altered pancreatic morphology and function. A spectrum of disease exists, and milder forms of disease may be missed by CT but demonstrated by endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS). The accuracy of ERCP and EUS for diagnosis of “minimal change” or “early” chronic pancreatitis is controversial, particularly when the results from these imaging procedures are discordant with each other or with tests of pancreatic function; in some cases ERCP and EUS should be considered indeterminate for diagnosis. This review discusses recent data concerning the accuracy of ERCP and EUS for diagnosis of chronic pancreatitis, the use of EUS fine-needle aspiration for differential diagnosis of pancreatic masses, and the use of EUS and EUS-guided TruCut biopsy for diagnosis of autoimmune pancreatitis.

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References and Recommended Reading

  1. Levy P, Barthet M, Mollard BR et al.: Estimation of the prevalence and incidence of chronic pancreatitis and its complications. Gastroenterol Clin Biol 2006, 30:838–844.

    Article  PubMed  Google Scholar 

  2. Kumar V, Nelso F, Abbas A: Robbins and Cotran Pathologic Basis of Disease, edn 7. Philadelphia: WB Saunders; 2004.

    Google Scholar 

  3. Ammann RW, Heitz PU, Kloppel G: Course of alcoholic chronic pancreatitis: a prospective clinicomorphological long-term study. Gastroenterology 1996, 111:224–231.

    Article  CAS  PubMed  Google Scholar 

  4. Stamm BH: Incidence and diagnostic significance of minor pathologic changes in the adult pancreas at autopsy: a systematic study of 112 autopsies in patients without known pancreatic disease. Human Pathol 1984, 15:677–683.

    Article  CAS  Google Scholar 

  5. Schmitz-Moormann P, Himmelmann GW, Brandes JW, et al.: Comparative radiological and morphological study of human pancreas. Pancreatitis like changes in post mortem ductograms and their morphological pattern. Possible implication for ERCP. Gut 1985, 26:406–414.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Chong AK, Hawes R, Hoffman B, et al.: Diagnostic performance of endoscopic ultrasound for chronic pancreatitis: a comparison with histopathology. Gastrointest Endosc 2005, 61:AB77.

    Google Scholar 

  7. Malfertheiner P, Buchler M, Stanescu A, Ditschuneit H: Exocrine pancreatic function in correlation to ductal and parenchymal morphology in chronic pancreatitis. Hepatogastroenterology 1986, 33:110–114.

    CAS  PubMed  Google Scholar 

  8. Heij HA, Obertop H, van Blankenstein M, et al.: Comparison of endoscopic retrograde pancreatography with functional and histologic changes in chronic pancreatitis. Acta Radiol 1987, 28:289–293.

    Article  CAS  PubMed  Google Scholar 

  9. The International Working Group for Minimal Standard terminology in Gastrointestinal Endosonography: Minimal standard terminology in gastrointestinal endosonography. Dig Endosc 1998, 10:159–184.

    Google Scholar 

  10. Fernandez-del Castillo C, Targarona J, Thayer SP, et al.: Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg 2003, 138:427–423.

    Article  PubMed  Google Scholar 

  11. Thuler FP, Costa PP, Paulo GA, et al.: Endoscopic ultrasonography and alcoholic patients: can one predict early pancreatic tissue abnormalities? JOP 2005, 6:568–574.

    PubMed  Google Scholar 

  12. Yusoff IF, Sahai AV: A prospective, quantitative assessment of the effect of ethanol and other variables on the endosonographic appearance of the pancreas. Clin Gastroenterol Hepatol 2004, 2:405–409.

    Article  PubMed  Google Scholar 

  13. Rajan E, Clain JE, Levy MJ, et al.: Age-related changes in the pancreas identified by EUS: a prospective evaluation. Gastrointest Endosc 2005, 61:401–406.

    Article  PubMed  Google Scholar 

  14. Catalano MF, Lahoti S, Geenen JE, Hogan WJ: Prospective evaluation of endoscopic ultrasonography, endoscopic retrograde pancreatography, and secretin test in the diagnosis of chronic pancreatitis. Gastrointest Endosc 1998, 48:11–17.

    Article  CAS  PubMed  Google Scholar 

  15. Chowdhury R, Bhutani MS, Mishra G. et al.: Comparative analysis of direct pancreatic function testing versus morphological assessment by endoscopic ultrasonography for the evaluation of chronic unexplained abdominal pain of presumed pancreatic origin. Pancreas 2005, 31:63–68.

    Article  PubMed  Google Scholar 

  16. Wiersema MJ, Hawes RH, Lehman GA, et al.: Prospective evaluation of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in patients with chronic abdominal pain of suspected pancreatic origin. Endoscopy 1993, 25:555–564.

    Article  CAS  PubMed  Google Scholar 

  17. DeWitt J, McGreevy K, LeBlanc J, et al.: EUS-guided Trucut biopsy of suspected nonfocal chronic pancreatitis. Gastrointest Endosc 2005, 62:76–84.

    Article  PubMed  Google Scholar 

  18. Iglesias-Garcia J, Abdulkader I, Larino-Noia J, et al.: Histological evaluation of chronic pancreatitis by endoscopic ultrasound-guided fine needle biopsy. Gut 2006, 55:1661–1662.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Martin ED: Different pathomorphological aspects of pancreatic fibrosis, correlated with etiology: Anatomical study of 300 cases. In Pancreatitis Concepts and Classification, Proceedings of the Second International Symposium on the Classification of Pancreatitis. Philadelphia: Elsevier Science Publishers; 1984:77–82

    Google Scholar 

  20. Pitchumoni CS, Glasser M, Saran RM, et al.: Pancreatic fibrosis in chronic alcoholics and nonalcoholics without clinical pancreatitis. Am J Gastroenterol 1984, 79:382–388.

    CAS  PubMed  Google Scholar 

  21. Brentnall TA, Bronner MP, Byrd DR, et al.: Early diagnosis and treatment of pancreatic dysplasia in patients with a family history of pancreatic cancer. Ann Intern Med 1999, 131:247–255.

    Article  CAS  PubMed  Google Scholar 

  22. Canto MI, Goggins M, Hruban RH, et al.: Screening for early pancreatic neoplasia in high-risk individuals: a prospective controlled study. Clin Gastroenterol Hepatol 2006, 4:766–781.

    Article  PubMed  Google Scholar 

  23. Draganov P, Patel A, Fazel A, et al.: Prospective evaluation of the accuracy of the intraductal secretin stimulation test in the diagnosis of chronic pancreatitis. Clin Gastroenterol Hepatol 2005, 3:695–699.

    Article  CAS  PubMed  Google Scholar 

  24. Tamura R, Ishibashi T, Takahashi S: Chronic pancreatitis: MRCP versus ERCP for quantitative caliber measurement and qualitative evaluation. Radiology 2006, 238:920–928.

    Article  PubMed  Google Scholar 

  25. Keiles S, Kammesheidt A: Identification of CFTR, PRSS1, and SPINK1 mutations in 381 patients with pancreatitis. Pancreas 2006, 33:221–227.

    Article  CAS  PubMed  Google Scholar 

  26. Alazmi WM, Fogel EL, Schmidt S, et al.: ERCP findings in idiopathic pancreatitis: patients who are cystic fibrosis gene positive and negative. Gastrointest Endosc 2006, 63:234–239.

    Article  PubMed  Google Scholar 

  27. Fritscher-Ravens A, Brand L, Knofel WT, et al.: Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis. Am J Gastroenterol 2002, 97:2768–2775.

    Article  PubMed  Google Scholar 

  28. Varadarajulu S, Tamhane A, Eloubeidi MA: Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis. Gastrointest Endosc 2005, 62:728–736.

    Article  PubMed  Google Scholar 

  29. Saftoiu A, Vilman P: Endoscopic ultrasound elastography: a new imaging technique for the visualization of tissue elasticity distribution. J Gastrointest Liver Dis 2006, 15:161–165.

    Google Scholar 

  30. Hocke M, Schulze E, Gottschalk P, et al.: Contrast-enhanced endoscopic ultrasound in discrimination between focal pancreatitis and pancreatic cancer. World J Gastroenterol 2006, 12:246–250.

    PubMed  Google Scholar 

  31. Takahashi K, Yamao K, Okubo K, et al.: Differential diagnosis of pancreatic cancer and focal pancreatitis by using EUS-guided FNA. Gastrointest Endosc 2005, 61:76–79.

    Article  PubMed  Google Scholar 

  32. Yan L, McFaul C, Howes N, et al.: Molecular analysis to detect pancreatic ductal adenocarcinoma in high-risk groups. Gastroenterology 2005, 128:2124–2130.

    Article  CAS  PubMed  Google Scholar 

  33. Pugliese V, Pujic N, Saccomanno S, et al.: Pancreatic intraductal sampling during ERCP in patients with chronic pancreatitis and pancreatic cancer: cytologic studies and k-ras-2 codon 12 molecular analysis in 47 cases. Gastrointest Endosc 2001, 54:595–599.

    Article  CAS  PubMed  Google Scholar 

  34. Queneau PE, Adessi GL, Thibault P, et al.: Early detection of pancreatic cancer in patients with chronic pancreatitis: diagnostic utility of a K-ras point mutation in the pancreatic juice. Am J Gastroenterol 2001, 96:700–704.

    Article  CAS  PubMed  Google Scholar 

  35. Pungpapong S, Scolapio JS, Woodward TA, et al.: Is zinc concentration in pancreatic fluid a marker for pancreatic diseases? JOP 2005, 6:425–430.

    PubMed  Google Scholar 

  36. Chari ST, Smyrk TC, Levy MJ, et al.: Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol 2006, 4:1010–1016.

    Article  PubMed  Google Scholar 

  37. Choi EK, Kim MH, Kim JC, et al.: The Japanese diagnostic criteria for autoimmune chronic pancreatitis: is it completely satisfactory? Pancreas 2006, 33:13–19.

    Article  PubMed  Google Scholar 

  38. Levy MJ, Reddy RP, Wiersema MJ: EUS-guided trucut biopsy in establishing autoimmune pancreatitis as the cause of obstructive jaundice. Gastrointest Endosc 2005, 61:467–472.

    Article  PubMed  Google Scholar 

  39. Levy MJ, Wiersema MJ, Chari ST: Chronic pancreatitis: focal pancreatitis or cancer? Is there a role for FNA/biopsy? Autoimmune pancreatitis. Endoscopy 2006, 38(Suppl 1): S30–S35.

    Article  PubMed  Google Scholar 

  40. Deshpande V, Mino-Kenudson M, Brugge WR, et al.: Endoscopic ultrasound guided fine needle aspiration biopsy of autoimmune pancreatitis: diagnostic criteria and pitfalls. Am J Surg Pathol 2005, 29:1464–1471.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic and College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Mark Topazian MD

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  1. Ferga C. Gleeson MD
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Correspondence to Mark Topazian MD.

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Gleeson, F.C., Topazian, M. Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound for diagnosis of chronic pancreatitis. Curr Gastroenterol Rep 9, 123–129 (2007). https://doi.org/10.1007/s11894-007-0006-3

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  • DOI: https://doi.org/10.1007/s11894-007-0006-3

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