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Quantitative diagnosis of chronic pancreatitis using EUS elastography

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

It is difficult to diagnose chronic pancreatitis (CP) objectively because of a lack of standard diagnostic criteria. Endoscopic ultrasonography (EUS) has been used to assess the severity of CP, but the diagnosis of CP using EUS depends on an endosnonographer. The aim of this study was to establish an objective diagnostic method for CP using EUS elastography (EUS-EG).

Methods

A retrospective study was designed and 96 patients underwent EUS-EG for follow-up of known CP, or who were clinically suspected as having CP. CP patients were categorized CP patients as 4 stages using the Rosemont classification (RC). EUS-EG was performed and the “Mean value”, which was negatively correlated with pancreatic fibrosis, was calculated using histogram analysis.

Results

The “Mean value” of each RC stage (normal, indeterminate for CP, suggestive of CP, and consistent with CP) was 90.1 ± 19.3, 73.2 ± 10.6, 63.7 ± 14.2, and 56.1 ± 13.6, respectively, and showed significant differences for each stage (p < 0.001). There was a significant negative correlation between the “Mean value” and the number of EUS features (r s = −0.59, p < 0.001). Multiple linear regression analysis was used to assess the diagnostic finding of the “Mean value” and showed that hyperechoic foci with shadowing and lobularity with honeycombing maintained their independent diagnostic findings.

Conclusions

EUS-EG was an objective diagnostic apparatus for CP and provided objective information to support EUS features.

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References

  1. Steer ML, Waxman I, Freedman S. Chronic pancreatitis. N Engl J Med. 1995;332:1482–90.

    Article  CAS  PubMed  Google Scholar 

  2. Catalano MF, Sahai A, Levy M, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc. 2009;69(7):1251–61.

    Article  PubMed  Google Scholar 

  3. 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;25:555–64.

    Article  CAS  PubMed  Google Scholar 

  4. Catalano MF, Lahoti S, Geenen JE, et al. Prospective evaluation of endoscopic ultrasonography, endoscopic retrograde pancreatography, and secretin test in the diagnosis of chronic pancreatitis. Gastrointest Endosc. 1998;48:11–7.

    Article  CAS  PubMed  Google Scholar 

  5. Sahai AV, Zimmerman M, Aabakken L, et al. Prospective assessment of the ability of endoscopic ultrasound to diagnose, exclude, or establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography. Gastrointest Endosc. 1998;48:18–25.

    Article  CAS  PubMed  Google Scholar 

  6. Hollerbach S, Klamann A, Topalidis T, et al. Endoscopic ultrasonography (EUS) and fine-needle aspiration (FNA) cytology for diagnosis of chronic pancreatitis. Endoscopy. 2001;33:824–31.

    Article  CAS  PubMed  Google Scholar 

  7. Duggan SN, Ní Chonchubhair HM, Lawal O, et al. Chronic pancreatitis: a diagnostic dilemma. World J Gastroenterol. 2016;22(7):2304–13.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Stevens T, Lopez R, Adler DG, et al. Multicenter comparison of the interobserver agreement of standard EUS scoring and Rosemont classification scoring for diagnosis of chronic pancreatitis. Gastrointest Endosc. 2010;71(3):519–26.

    Article  PubMed  Google Scholar 

  9. Shiina T. JSUM ultrasound elastography practice guidelines: basics and terminology. J Med Ultrason. 2013;40(4):309–23.

    Article  Google Scholar 

  10. Hirooka Y, Kuwahara T, Shiina T, et al. JSUM ultrasound elastography practice guidelines: pancreas. J Med Ultrason. 2015;42(2):151–74.

    Article  Google Scholar 

  11. Uchida H, Hirooka Y, Itoh A, et al. Utility of elastography in the diagnosis of pancreatic diseases using transabdominal ultrasonography. Gastroenterology. 2005;128(4):A536.

    Google Scholar 

  12. Itoh Y, Itoh A, Kawashima H, et al. Quantitative analysis of diagnosing pancreatic fibrosis using EUS-elastography (comparison with surgical specimens). J Gastroenterol. 2014;49:1183–92.

    Article  PubMed  Google Scholar 

  13. World Medical Association Inc. Declaration of Helsinki. Ethical principles for medical research involving human subjects. J Indian Med Assoc. 2009;107:403–5.

    Google Scholar 

  14. Haralick RM, Shanmuga K, Dinstein I. Textural features for image classification. IEEE Trans Syst Man Cybern. 1973;3:610–21.

    Article  Google Scholar 

  15. Yashima Y, Sasahira N, Isayama H, et al. Acoustic radiation force impulse elastography for noninvasive assessment of chronic pancreatitis. J Gastroenterol. 2012;47(4):427–32.

    Article  PubMed  Google Scholar 

  16. Iglesias-Garcia J, Domínguez-Muñoz JE, Castiñeira-Alvariño M, et al. Quantitative elastography associated with endoscopic ultrasound for the diagnosis of chronic pancreatitis. Endoscopy. 2013;45(10):781–8.

    Article  PubMed  Google Scholar 

  17. Hirche TO, Ignee A, Barreiros AP, et al. Indications and limitations of endoscopic ultrasound elastography for evaluation of focal pancreatic lesions. Endoscopy. 2008;40:910–7.

    Article  CAS  PubMed  Google Scholar 

  18. Varadarajulu S, Eltoum I, Tamhane A, et al. Histopathologic correlates of noncalcific chronic pancreatitis by EUS: a prospective tissue characterization study. Gastrointest Endosc. 2007;66:501–9.

    Article  PubMed  Google Scholar 

  19. Chong AKH, Hawes RH, Hoff man BJ, et al. Diagnostic performance of EUS for chronic pancreatitis: a comparison with histopathology. Gastrointest Endosc. 2007;65:808–14.

    Article  PubMed  Google Scholar 

  20. Albashir S, Bronner MP, Parsi MA, et al. Endoscopic ultrasound, secretin endoscopic pancreatic function test, and histology: correlation in chronic pancreatitis. Am J Gastroenterol. 2010;105:2498–503.

    Article  PubMed  Google Scholar 

  21. LeBlanc JK, Chen J-H, Al-Haddad M, et al. Endoscopic ultrasound and histology in chronic pancreatitis: how are they associated? Pancreas. 2014;43:440–4.

    Article  PubMed  Google Scholar 

  22. Trikudanathan G, Vega-Peralta J, Malli A, et al. Diagnostic performance of endoscopic ultrasound (EUS) for non-calcific chronic pancreatitis (NCCP) based on histopathology. Am J Gastroenterol. 2016;111(4):568–74.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Yoshiki Hirooka.

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The authors declare that they have no conflicts of interest relating to this study.

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Kuwahara, T., Hirooka, Y., Kawashima, H. et al. Quantitative diagnosis of chronic pancreatitis using EUS elastography. J Gastroenterol 52, 868–874 (2017). https://doi.org/10.1007/s00535-016-1296-8

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  • DOI: https://doi.org/10.1007/s00535-016-1296-8

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