Copyright ©The Author(s) 2021.
World J Gastroenterol. Jul 21, 2021; 27(27): 4342-4357
Published online Jul 21, 2021. doi: 10.3748/wjg.v27.i27.4342
Table 1 Revised TIGAR-O aetiology criteria
0 to < 1 drinks/d
1-2 drinks/d
3-4 drinks/d
5 or more drinks/d
Non-smoker (< 100 cigarettes in lifetime)
Past smoker
Current smoker (patients undergoing both past and ongoing cigarette exposure)
Other, not otherwise specified
Hypercalcaemia (total calcium levels > 12.0 mg/dL or 3 mmol/L)
Hypertriglyceridemia risk (fasting glucose > 300 mg/dL; non-fasting glucose > 500 mg/dL)
Hypertriglyceridemia in acute pancreatitis (history of glucose > 500 mg/dL in first 72 h of AP onset)
Toxins, other
Chronic kidney disease [CKD Stage 5: end-stage renal disease (ESRD)]
Other, not otherwise specified
Early-onset (< 35 yr of age)
Late-onset (> 35 yr of age)
Suspected; no or limited genotyping available
Autosomal dominant (Mendelian inheritance-single gene syndrome)
PRSS1 mutations (hereditary pancreatitis)
Autosomal recessive (Mendelian inheritance-single gene syndrome)
CFTR, 2 severe variants in trans (cystic fibrosis)
CFTR, < 2 severe variants in trans (CFTR-RD)
SPINK1, 2 pathogenic variants in trans (SPINK1-associated familial pancreatitis)
Complex genetics (non-Mendelian, complex genotypes +/- environment)
Modifier Genes (pathogenic genetic variants)
PRSS1-PRSS1 locus
CLDN2 locus
Other, not otherwise specified
Autoimmune pancreatitis (AIP)/ steroid responsive pancreatitis
AIP Type 1—IgG4-related disease
AIP Type 2
Recurrent acute pancreatitis (RAP) and severe acute pancreatitis (SAP)
Acute pancreatitis (single episode, including date of event if available)
AP aetiology—Extra-pancreatic (excluding alcoholic, HTG, hypercalcaemia, genetic)
Biliary pancreatitis
Undetermined or not otherwise specified
Recurrent acute pancreatitis (number of episodes, frequency, and dates of events if available)
Pancreas divisum
Ampullary stenosis
Main duct pancreatic stones
Widespread pancreatic calcifications
Main pancreatic duct strictures
Localized mass causing duct obstruction
Table 2 Comparisons of diagnostic modalities
Diagnostic standards
AetiologyTIGAR-O classification (version 2)[13].--
Clinical presentationThree or more of the following features: Abnormal serum or urine pancreatic enzyme concentrations; continuous heavy alcohol consumption (> 80 g alcohol/day or more than 5 drinks/day), family history of hereditary chronic pancreatitis, or known sporadic high-risk mutations; recurring epigastric abdominal pain; and abnormal exocrine function. Genetic pancreatitis should be suspected in young patients with clinical presentations but without a history of risk factors.--
TA-USIrregular main pancreatic duct with a diameter > 3 mm, hyperechoic pancreatic duct wall, or lobularity with stranding.69% (95%CI: 54-80)94%(95%CI: 90-100)
CTTwo or more of the following features: MPD within 2-4 mm; mild organ enlargement; irregular main pancreatic duct with ≥ 3 pathological side branches; pseudocysts ≤ 10 mm; and heterogeneous parenchyma.75% (95%CI: 66-83)91%(95%CI: 81-96)
MRI/MRCPTwo or more of the following features: MPD 2-4 mm; mild organ enlargement; irregular main pancreatic duct with ≥ 3 pathological side branches; pseudocysts ≤ 10 mm; and heterogeneous parenchyma.Single-parametric: 77%; Multi-parametric: 91%Single-parametric: 83%; Multi-parametric: 86%
ERCPMore than three pathological side branches plus a normal MPD.82% (95% CI: 76-87)94% (95% CI: 87-98)
EUSMore than two of the following seven criteria, including at least one of criteria 1-4: (1) Stranding; (2) Hyperechoic foci without shadowing; (3) Lobularity with honeycombing; (4) Lobularity without honeycombing; (5) Cysts; (6) Dilated side branches; (7) Hyperechoic main pancreatic duct margin.61% (non-fibrosis); 84% (for fibrosis)75% (non-fibrosis); 100% (for fibrosis)
EUS-EGA strain ratio of > 10 or a mean strain histogram value of < 50 was associated with malignancy.The mean value can be used to diagnose mild or higher-grade fibrosis.76.4%91.7%
FE-1Moderate EPI can be diagnosed based on an abnormal FE-1 level of < 200 μg/g, which has a high false-positive rate.76.5%; 45.0% (mild ductal changes and insufficiency)86.0%
ePFTPeak bicarbonate concentration of < 80 mmol/L is considered abnormal and correlated with early fibrosis.86% (95%CI: 67-100)67% (95%CI: 13-100)
FNARuling out malignancy and staging of CP. CEA testing: Cut-off value of 192 ng/mL. Molecular analysis: KRAS and GNAS mutations.85% (pancreatic cancer)98% (pancreatic cancer)
nCLEA complementary modality for detecting subtle changes in early CP and helpful for distinguishing malignancies.94.3% (cystic lesions); 90.3% (PDAC)98.1% (cystic lesions); 89.5% (PDAC)