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World J Gastroenterol. Sep 14, 2010; 16(34): 4253-4263
Published online Sep 14, 2010. doi: 10.3748/wjg.v16.i34.4253
Endoscopic ultrasound in chronic pancreatitis: Where are we now?
Andrada Seicean
Andrada Seicean, Third Medical Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400162 Cluj-Napoca, Romania
Author contributions: Seicean A solely contributed to this paper.
Supported by A National Grant from the Education Ministry PANGEN PNII 42110/2008
Correspondence to: Andrada Seicean, MD, PhD, Third Medical Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, Croitorilor Street 19-21, 400162 Cluj-Napoca, Romania. andradaseicean@yahoo.com
Telephone: +40-264-433427 Fax: +40-264-431758
Received: April 28, 2010
Revised: June 12, 2010
Accepted: June 19, 2010
Published online: September 14, 2010

Endoscopic ultrasonography (EUS) is well suited for assessment of the pancreas due to its high resolution and the proximity of the transducer to the pancreas, avoiding air in the gut. Evaluation of chronic pancreatitis (CP) was an early target for EUS, initially just for diagnosis but later for therapeutic purposes. The diagnosis of CP is still accomplished using the standard scoring based on nine criteria, all considered to be of equal value. For diagnosis of any CP, at least three or four criteria must be fulfilled, but for diagnosis of severe CP at least six criteria are necessary. The Rosemont classification, more restrictive, aims to standardize the criteria and assigns different values to different features, but requires further validation. EUS-fine needle aspiration (EUS-FNA) is less advisable for diagnosis of diffuse CP due to its potential side effects. Elastography and contrast-enhanced EUS are orientation in differentiating a focal pancreatic mass in a parenchyma with features of CP, but they cannot replace EUS-FNA. The usefulness of EUS-guided celiac block for painful CP is still being debated with regard to the best technique and the indications. EUS-guided drainage of pseudocysts is preferred in non-bulging pseudocysts or in the presence of portal hypertension. EUS-guided drainage of the main pancreatic duct should be reserved for cases in which endoscopic retrograde cholangiopancreatography has failed owing to difficult cannulation of the papilla or difficult endotherapy. It should be performed only by highly skilled endoscopists, due to the high rate of complications.

Keywords: Endoscopic ultrasonography, Pancreatic neoplasms, Chronic pancreatitis, Contrast agents, Nerve block, Pancreatic pseudocyst, Drainage, Elastography, Main pancreatic duct