Endoscopic ultrasound for the diagnosis of chronic pancreatitis

Table 1 Evolution of endoscopic ultrasound criteria for chronic pancreatitis

	Lees[6] (1986)	Wiersema et al[2] (1993)	Sahai et al[8] (1998)	Catalano et al[9] (2009)1	Histological correlation
Number of criteria	Qualitative	11	9	3 major; 6 minor
Parenchymal	X	Reduced echogenic foci	X	X
		Heterogeneity
	Strongly echogenic foci	Echogenic foci (> 3 mm)	Hyperechoic foci	Hyperechoic foci without shadowing (minor). Echogenic structures ≥ 2 mm in length and width with no shadowing	Focal fibrosis
				Hyperechoic foci with shadowing (major A). Echogenic structures ≥ 2 mm in length and width that shadow	Calcifications in side-branches
	Echogenic bands	X	Hyperechoic strands	Stranding (minor). Hyperechoic lines of ≥ 3 mm in length in at least 2 different directions with respect to the imaged plane	Fibrotic bands
	Cavities	Cysts (> 3 mm)	Cysts	Cysts (minor). Anechoic, rounded/elliptical structures with or without septations	Pseudocysts
	Accentuation of lobular architecture	Accentuation of lobular pattern	Parenchymal lobularity	Lobularity with honeycombing (major B). Well-circumscribed, ≥ 5 mm structures with enhancing rim and relatively echo-poor center, with ≥ 3 contiguous lobules	Edema separated by fibrotic bands
				Lobularity without honeycombing (minor). Well-circumscribed, ≥ 5 mm structures with enhancing rim and relatively echo-poor center, with noncontiguous lobules
	Enlargement	X	X	X
Duct	X	Narrowing	X	X
	Increase in caliber	Dilation	MPD dilation	MPD dilation (minor). ≥ 3.5 mm in body or > 1.5 mm in tail	Obstructed duct
	Irregularity of the lumen	Irregular contour	Irregular MPD margins	Irregular MPD contour (minor). Uneven or irregular outline and ectatic course	Ductal fibrosis and strictures
	Increase echogenicity of duct wall	Duct wall echogenicity	Hyperechoic MPD margins	Hyperechoic MPD margin (minor). Echogenic, distinct structure greater than 50% of entire MPD in the body and tail	Periductal fibrosis
	Intraluminal echoes	Calculi	Shadowing calcifications	MPD calculi (major A). Echogenic structures within MPD with acoustic shadowing	Calcifications in the main duct
	Visualization of side branches	Side-branch dilation	Visible side-branches	Dilated side branches (minor). 3 or more tubular anechoic structures each measuring ≥ 1 mm in width, budding from the MPD	Side-branch ectasia
	Strictures with dilation	X	X	X
	Main or branch duct disruptions with cyst	X	X	X

¹Rosemont diagnostic stratification: Normal: < 3 minor features (excluding non-shadowing echogenic foci, visible side-branches, cysts, and MPD dilation) and no major features. Indeterminate: 3 or 4 minor features and no major features, or major B feature alone with < 3 minor features. Suggestive: 1 major A feature and < 3 minor features, or 1 major B feature and ≥ 3 minor features, or ≥ 5 minor features. Most consistent: 1 major A feature and ≥ 3 minor features, or 1 major A feature and major B feature, or 2 major A features. MPD: Main pancreatic duct.

Table 2 Test performance of endoscopic ultrasound in comparative studies

Study	Gold standard	Cut-point	Overall test performance		Minimal change CP test performance
			Sensitivity	Specificity	Sensitivity	Specificity
Buscail et al[11]	Composite	None	89% (39/44)	100% (18/18)	NR	NR
Nattermann et al[4]	ERCP	None	98% (50/51)	63% (27/43)	88% (7/8)	63% (27/43)
Wiersema et al[2]	ERCP	≥ 3	100% (19/19)	79% (38/48)	100% (18/18)	79% (38/48)
Catalano et al[3]	ERCP	≥ 3	86% (31/36)	95% (42/44)	82% (22/27)	95% (42/44)
Sahai et al[8]	ERCP	≥ 3	63% NR	68% NR	NR	NR
Hastier et al[25]	ERCP	None	93% (13/14)	NR	NR	NR
Hollerbach et al[36]	ERCP	Grade 0-3	97% (30/31)	67% (4/6)	95% (20/21)	67% (4/6)
Wiersema et al[2]	Secretin ID-PFT	≥ 3	67% (6/9)	29% (2/7)	67% (6/9)	29% (2/7)
Catalano et al[3]	Secretin ID-PFT	≥ 3	84% (21/25)	78% (43/55)	NR	NR
Raimondo et al[13]	CCK PFT	≥ 4	43% (3/7)	50% (4/8)	NR	NR
Chowdhury et al[14]	Secretin PFT	≥ 3	71% (5/7)	35% (5/14)	71% (5/7)	35% (5/14)
Stevens et al[15]	Secretin PFT	≥ 3	68% (34/50)	79% (30/38)	NR	NR
Stevens et al[16]	Secretin PFT	≥ 4	71% (17/24)	92% (24/26)	NR	NR
Stevens et al[16]	CCK PFT	≥ 4	63% (15/24)	85% (22/26)	NR	NR
Chong et al[19]	Histology	≥ 3	NR	NR	83% (30/36)	80% (4/5)
Varadarajulu et al[18]	Histology	≥ 4	91% (19/21)	86% (18/21)	91% (19/21)	86% (18/21)
Gupta et al[20]	Histology	≥ 3	71% (10/14)	100% (1/1)	71% (10/14)	100% (1/1)
Albashir et al[21]	Histology	≥ 4	75% (12/16)	NR	NR	NR
Bhutani et al[49]	Histology (Autopsy)	≥ 3	100% (10/10)	100% (1/1)	100% (10/10)	100% (1/1)
Kahl et al[22]	Baseline or repeat ERCP	≥ 1	100% (114/114)	NR	NR	NR
Morris-Stiff et al[24]	Radiographic progression	None	100% (13/13)	NR	100% (13/13)	NR

Calc: Calcification; CCK: Cholecystokinin; NR: Not reported or calculable; PFT: Pancreatic function test; ID-PFT: Intraductal pancreatic function test.