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Copyright ©The Author(s) 2016.
World J Gastroenterol. Feb 21, 2016; 22(7): 2304-2313
Published online Feb 21, 2016. doi: 10.3748/wjg.v22.i7.2304
Table 1 Rosemont criteria for chronic pancreatitis
Parenchymal features
Major AHyperechoic foci with stranding
Major BLobularity with honeycombing
MinorHyperechoic foci
Lobularity
Cysts
Hyperechoic strands
Ductal features
Major ACalculi
MinorMain pancreatic duct dilation
Irregular main pancreatic duct contour
Hyperechoic main pancreatic duct margin
Dilated side branches
Table 2 Endoscopic ultrasound diagnosis of chronic pancreatitis on the basis of Rosemont criteria
Consistent with chronic pancreatitis1 major A feature + ≥ 3 minor features or
1 major A feature + major B feature or
2 major A features
Suggestive of chronic pancreatitis1 major A feature + < 3 minor features or
1 major B + ≥ 3 minor features or
≥ 5 minor features
Indeterminate for chronic pancreatitis3 or 4 minor features, no major features or
Major B feature alone with < 3 minor features
Normal ≤ 2 minor features, no major features
Table 3 A summary of the APA diagnostic guidelines (2014)
TopicLevel
Epidemiology and risk factorsData on population-based estimates are emergingC/L
A small fraction of patients progress from AP to CPC/M
Alcohol/smoking are independent risk factors for CP. Both are associated with disease progression and their risks are likely multiplicativeS/H
The spectrum of risk factors for CP has broadenedC/L
Genetic discoveries are rapidly uncovering new susceptibility factors. Knowledge of gene-environment interactions may translate into new diagnostic and treatment paradigmsS/M
Pathological DefinitionsCP is characterized by atrophy and fibrosis of the exocrine tissue with or without chronic inflammation-
Scarring of the parenchyma may be focal, patchy or diffuse-
Progressive fibrosis and atrophy may lead to exocrine insufficiency followed by endocrine insufficiency-
Autoimmune pancreatitis can mimic pancreas carcinoma-
Ultrasound and CTUltrasound and CT are best for late findings of CP but are limited in the diagnosis of early or mild pancreatitisC/M
Intraductal pancreatic calcifications are the most specific and reliable sonographic and CT signs of CPS/M
CT is helpful for the diagnosis of complications of CPS/M
CT is helpful for the diagnosis of other conditions that can mimic CTC/L
MRI imagingCompared with ultrasound and CT, MRI is a more sensitive imaging tool for the diagnosis of CTC/M
Ductal abnormalities are very specific and reliable MRI signs of CPC/L
Signal intensity changes in the pancreas, seen on MRI, may precede ductal abnormalities and suggest early CTC/L
Stimulation of the pancreas using IV secretin may improve the diagnostic accuracy in the detection of ductal and parenchymal abnormalities seen on CTC/L
Endoscopic ultrasoundThe ideal threshold number of EUS criteria necessary to diagnose CP has not been firmly established, but the presence of 5 or more or 2 or less strongly suggests or refutes the diagnosis of CPS/L
The EUS features of CP are not necessarily pathologic and may occur as a normal aging, as a normal variant, or due to the nonpathologic asymptomatic fibrosis in the absence of endocrine/exocrine dysfunctionS/L
The relatively poor IOA for EUS CP features limits the diagnostic accuracy and overall utility of the EUS for diagnosing CPS/M
ERCPERP is rarely used for diagnostic purposesS/M
The correlation between the Cambridge criteria and histology is highest in advanced CPS/M
Multiple confounders limit the interpretation of ductal changes by Cambridge criteriaS/L
Indirect PFTsIndirect PFTs generally are sensitive for steatorrhea and useful in quantifying the degree of exocrine insufficiencyC/L
Indirect PFTs are moderately sensitive and specific for diagnosing advanced CP but are less so for diagnosing early CPC/S
The FE-1 assay, polyclonal assay more than monoclonal, can be limited in specificity, especially if the stool has is watery and/or in the presence of small bowel diseaseC/L
Faecal chymotrypsin may be useful in detecting compliance with exogenous pancreatic enzyme supplementationC/L
Faecal fat assays are sensitive for steatorrhea but are of limited utility due to the cumbersome nature of patient collection and laboratory handling of samples. In addition, strict adherence to dietary recommendations for several days is requiredC/M
Direct PFTsDirect PFTs have high sensitivity for detecting late CP, but lower sensitivity (70%-75%) for early CPS/L
The traditional secretin and CCK PFTs performed with the aortoduodenal tube pancreas fluid collection are highly accurate but require fluoroscopy for confirmation of tube placement and are not widely utilizedS/M
The ePFT has good correlation with the traditional Dreiling PFTS/M
Correlation of imaging and function with histologyAs structural severity worsens in CP, exocrine function declinesS/M
Both EUS and PFT results correlate with fibrosis in CPC/L
A combined approach (e.g., EUS/ePFT) could improve detection of minimal change CP (MCCP)C/L