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.
Similar content being viewed by others
References
Steer ML, Waxman I, Freedman S. Chronic pancreatitis. N Engl J Med. 1995;332:1482–90.
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.
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.
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.
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.
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.
Duggan SN, Ní Chonchubhair HM, Lawal O, et al. Chronic pancreatitis: a diagnostic dilemma. World J Gastroenterol. 2016;22(7):2304–13.
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.
Shiina T. JSUM ultrasound elastography practice guidelines: basics and terminology. J Med Ultrason. 2013;40(4):309–23.
Hirooka Y, Kuwahara T, Shiina T, et al. JSUM ultrasound elastography practice guidelines: pancreas. J Med Ultrason. 2015;42(2):151–74.
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.
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.
World Medical Association Inc. Declaration of Helsinki. Ethical principles for medical research involving human subjects. J Indian Med Assoc. 2009;107:403–5.
Haralick RM, Shanmuga K, Dinstein I. Textural features for image classification. IEEE Trans Syst Man Cybern. 1973;3:610–21.
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.
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.
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.
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.
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.
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.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest relating to this study.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00535-016-1296-8