EndoscopicUltrasoundinChronicPancreatitis.ppt

* From UAB, 42 patients --2nd table: Sensitivity, specificity for individual EUS features for CP * -Cleveland Clinic -Patients with chronic abd. Pain undergoing evaluation for presence of CP; total of 83 -ERCP is a sensitive test to evaluate ductal changes however drawbacks would include no evaluation of the parenchyma, risk of pancreatitis…duct changes can be normal finding in elderly as well as those who drink alcohol but don’t have clinical evidence of pancreatitis -pancreatic FT is used as a reference standard as it detects mild exocrine insufficiency as a surrogate for fibrosis (drawback is often normal in early stages of CP)—duod. Aspirate over 60 minutes after IV secretin, peak bicarb administration 80 was diagnostic * Kappa 0.69 * --Rosemont, IL; in 2007, group of experts from US and Japan --Wanted to divide criterion into major and minor based on their relative positive predictive value for CP * --EUS scanning for CP in the pancreatic head were not recommend, because the ventral pancreas is normally more hypoechoic than the dorsal gland and, therefore, may falsely show pancreatic abnormalities * --Results of the deliberations do not provide validation for the recommendations --Feel that these guidelines represent an improvement over the previous means of EUS diagnosis, which assigned equal importance to each criterion * May ask “why not just take a biopsy while doing the EUS?”—low accuracy, risky * A Normal pancreatic duct and parenchyma. B Mild EUS changes (four criteria: lobularity, hyperechoic foci and strands, duct irregularity). C Severe EUS parenchymal changes (hyperechoic foci and strands, parenchymal calcifications, cystic change, lobularity). D Severe ductal EUS changes (ductal dilation and intraductal calcification) * * Honeycomb appearance * * * -Because focal pancreatitis and adenocarcinoma have similar EUS appearance -The inflammatory infiltrate may obscure or simulate a pancreatic malignancy --Compounded by the facts that patients with chroni