American Pancreatic Association practice guidelines in chronic pancreatitis evidence-based report on diagnostic guidelines

Darwin L. Conwell, Linda S. Lee, Dhiraj Yadav, Daniel S. Longnecker, Frank H. Miller, Koenraad J. Mortele, Michael J. Levy, Richard Kwon, John G. Lieb, Tyler Stevens, Phillip P. Toskes, Timothy B. Gardner, Andres Gelrud, Bechien U. Wu, Christopher E. Forsmark, Santhi S. Vege

Research output: Contribution to journalArticlepeer-review

318 Scopus citations


The diagnosis of chronic pancreatitis remains challenging in early stages of the disease. This report defines the diagnostic criteria useful in the assessment of patients with suspected and established chronic pancreatitis. All current diagnostic procedures are reviewed, and evidence-based statements are provided about their utility and limitations. Diagnostic criteria for chronic pancreatitis are classified as definitive, probable, or insufficient evidence. A diagnostic (STEP-wise; survey, tomography, endos-copy, and pancreas function testing) algorithm is proposed that proceeds from a noninvasive to a more invasive approach. This algorithm maximizes specificity (low false-positive rate) in subjects with chronic abdominal pain and equivocal imaging changes. Furthermore, a nomenclature is suggested to further characterize patients with established chronic pancreatitis based on TIGAR-O (toxic, idiopathic, genetic, autoimmune, recurrent, and obstructive) etiology, gland morphology (Cambridge criteria), and physiologic state (exocrine, endocrine function) for uniformity across future multicenter research collaborations. This guideline will serve as a baseline manuscript that will be modified as new evidence becomes available and our knowledge of chronic pancreatitis improves.

Original languageEnglish
Pages (from-to)1143-1162
Number of pages20
Issue number8
StatePublished - Nov 10 2014

Bibliographical note

Publisher Copyright:
Copyright © 2014 by Lippincott Williams & Wilkins.


  • Chronic pancreatitis
  • Diagnosis
  • Evidence-based
  • Guidelines

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology


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