Comparison of endoscopic ultrasound and endoscopic retrograde pancreatography for the prediction of pancreatic exocrine insufficiency

Tyler Stevens, Darwin L. Conwell, Gregory Zuccaro, John J. Vargo, John A. Dumot, Rocio Lopez

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37 Citations (SciVal)

Abstract

Endoscopic retrograde pancreatography (ERP) is a sensitive test for the early ductal changes of chronic pancreatitis. More recently, endoscopic ultrasound (EUS) has also been proposed as a sensitive structural test for chronic pancreatitis. Few studies have compared EUS and ERP using an external reference standard. Direct pancreatic function tests (PFT) are an acceptable reference standard for chronic pancreatitis since they detect mild exocrine insufficiency. Our aim was to compare structural abnormalities as revealed by ERP and EUS for the prediction of exocrine insufficiency. Eight-three patients who underwent EUS, ERP, and secretin PFT for the evaluation of pancreatitis were identified from our database. Exocrine insufficiency was defined as a secretin PFT peak bicarbonate concentration <80 mEq/l. Based on the number of abnormal sonographic criteria observed, EUS findings were categorized as normal (<2 criteria), mild (3-5 criteria) or severe (6-9 criteria or calcifications). ERP findings were categorized based on the Cambridge classification. ERP and EUS did not differ significantly in either sensitivity (72% vs 68%, P = 0.52) or specificity (76% vs 79%, P = 0.40). ERP and EUS were similarly associated with exocrine insufficiency both in the presence of minimal (OR 3.4 and 4.9, respectively) and severe structural changes (OR 12 and 24, respectively). We consider EUS to have a diagnostic accuracy for the structural diagnosis of early- and late-stage chronic pancreatitis similar to that of ERP.

Original languageEnglish
Pages (from-to)1146-1151
Number of pages6
JournalDigestive Diseases and Sciences
Volume53
Issue number4
DOIs
StatePublished - Apr 2008

Bibliographical note

Funding Information:
Acknowledgments This research was presented at the Presidential Plenary Session of the American College of Gastroenterology Meeting 2006, Las Vegas, NV. Support was provided by an unrestricted education and research grant from Solvay Pharmaceuticals (Marietta, GA).Conflict of interest Guarantor of the article: Tyler Stevens, M.D. Specific author contributions: Tyler Stevens (conception and design, analysis and interpretation, drafting of the article, final approval), Darwin Conwell (critical revision), Gregory Zuccaro (critical revision), John Vargo (critical revision), John A. Dumot (critical revision), Rocio Lopez (analysis and interpretation). Financial support: No financial conflict of interest. Potential competing interests: None.

Keywords

  • Chronic pancreatitis
  • Endoscopic retrograde cholangiopancreatography
  • Endoscopic ultrasound
  • Pancreatic function testing
  • Secretin

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

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