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Endoscopic ultrasound for the diagnosis of chronic pancreatitis  [cached]
Tyler Stevens, Mansour A Parsi
World Journal of Gastroenterology , 2010,
Abstract: Endoscopic ultrasound (EUS) has become a well accepted test for the diagnosis of chronic pancreatitis. Advantages include its ability to detect subtle and severe changes of the pancreatic duct and parenchyma, and its relative safety compared with endoscopic retrograde cholangiopancreatography. Limitations include inter- and intra-observer variability, operator dependence, and an incomplete understanding of its true accuracy. The Rosemont classification has recently been proposed as a weighted, standardized method that may improve EUS chronic pancreatitis scoring. This paper reviews the published evidence regarding the accuracy of EUS in chronic pancreatitis diagnosis, and enumerates the emerging technologies that have been recently studied which may ultimately improve endosonographic imaging of the pancreas.
Endoscopic ultrasound in chronic pancreatitis: Where are we now?  [cached]
Andrada Seicean
World Journal of Gastroenterology , 2010,
Abstract: Endoscopic ultrasonography (EUS) is well suited for assessment of the pancreas due to its high resolution and the proximity of the transducer to the pancreas, avoiding air in the gut. Evaluation of chronic pancreatitis (CP) was an early target for EUS, initially just for diagnosis but later for therapeutic purposes. The diagnosis of CP is still accomplished using the standard scoring based on nine criteria, all considered to be of equal value. For diagnosis of any CP, at least three or four criteria must be fulfilled, but for diagnosis of severe CP at least six criteria are necessary. The Rosemont classification, more restrictive, aims to standardize the criteria and assigns different values to different features, but requires further validation. EUS-fine needle aspiration (EUS-FNA) is less advisable for diagnosis of diffuse CP due to its potential side effects. Elastography and contrast-enhanced EUS are orientation in differentiating a focal pancreatic mass in a parenchyma with features of CP, but they cannot replace EUS-FNA. The usefulness of EUS-guided celiac block for painful CP is still being debated with regard to the best technique and the indications. EUS-guided drainage of pseudocysts is preferred in non-bulging pseudocysts or in the presence of portal hypertension. EUS-guided drainage of the main pancreatic duct should be reserved for cases in which endoscopic retrograde cholangiopancreatography has failed owing to difficult cannulation of the papilla or difficult endotherapy. It should be performed only by highly skilled endoscopists, due to the high rate of complications.
Endoscopic and anesthetic feasibility of EUS and ERCP combined in a single session versus two different sessions  [cached]
Juan J Vila, Marcos Kutz, Silvia Go?i, Miriam Ostiz, Edurne Amorena, Carlos Prieto, Cristina Rodriguez, Ignacio Fernández-Urien, Francisco J Jiménez
World Journal of Gastrointestinal Endoscopy , 2011,
Abstract: AIM: To discuss the feasibility of single session endoscopic ultrasonography (EUS) to discuss and endoscopic retrograde cholangiopancreatography (ERCP) execution.METHODS: Retrospective endoscopic and anesthetic outcome comparison of performing both EUS and ERCP in a single endoscopic session (Group I) versus performing each procedure in two different sessions (Group II) was made. The following variables were evaluated: epidemiological variables, American Society of Anesthesiologists Physical Status Classification (ASA) level, procedural time, propofol dose, anesthetic complications, endoscopic complications and diagnostic yield, and therapeutic procedures on both groups. T-student, Chi-Square and Fisher test were used for comparison.RESULTS: We included 39 patients in Group I (mean age: 69.85 ± 9.25; 27 men) and 46 in Group II (mean age: 67.46 ± 12.57; 25 men). Procedural time did not differ significantly between both groups (Group Ivs Group II: 93 ± 32.78 vs 98.98 ± 38.17; P >0.05) but the dose of propofol differed (Group I vs Group II: 322.28 ± 250.54 mg vs 516.96 ± 289.06 mg; P = 0.001). Three patients had normal findings on both explorations. Three anesthetic complications [O2 desaturation (2), broncoaspiration (1)] and 9 endoscopic complications [pancreatitis (6), bleeding (1), perforation (1), cholangitis (1)] occurred without significant differences between both groups (P > 0.05). We did not find any significant difference regarding age, sex, ASA scale level, diagnostic yield or therapeutic maneuvers between both groups.CONCLUSION: The performance of EUS and ERCP in a single session offers a similar diagnostic and therapeutic yield, does not entail a higher complication risk and requires a significantly smaller dose of propofol for sedation compared with performing each exploration in a different session.
Differentiation of Pancreatic Cancer and Chronic Pancreatitis Using Computer-Aided Diagnosis of Endoscopic Ultrasound (EUS) Images: A Diagnostic Test  [PDF]
Maoling Zhu, Can Xu, Jianguo Yu, Yijun Wu, Chunguang Li, Minmin Zhang, Zhendong Jin, Zhaoshen Li
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0063820
Abstract: Background Differentiating pancreatic cancer (PC) from normal tissue by computer-aided diagnosis of EUS images were quite useful. The current study was designed to investigate the feasibility of using computer-aided diagnostic (CAD) techniques to extract EUS image parameters for the differential diagnosis of PC and chronic pancreatitis (CP). Methodology/Principal Findings This study recruited 262 patients with PC and 126 patients with CP. Typical EUS images were selected from the sample sets. Texture features were extracted from the region of interest using computer-based techniques. Then the distance between class algorithm and sequential forward selection (SFS) algorithm were used for a better combination of features; and, later, a support vector machine (SVM) predictive model was built, trained, and validated. Overall, 105 features of 9 categories were extracted from the EUS images for pattern classification. Of these features, the 16 were selected as a better combination of features. Then, SVM predictive model was built and trained. The total cases were randomly divided into a training set and a testing set. The training set was used to train the SVM, and the testing set was used to evaluate the performance of the SVM. After 200 trials of randomised experiments, the average accuracy, sensitivity, specificity, the positive and negative predictive values of pancreatic cancer were 94.2±0.1749%,96.25±0.4460%, 93.38±0.2076%, 92.21±0.4249% and 96.68±0.1471%, respectively. Conclusions/Significance Digital image processing and computer-aided EUS image differentiation technologies are highly accurate and non-invasive. This technology provides a kind of new and valuable diagnostic tool for the clinical determination of PC.
Is acute recurrent pancreatitis a chronic disease?  [cached]
Alberto Mariani, Pier Alberto Testoni
World Journal of Gastroenterology , 2008,
Abstract: Whether acute recurrent pancreatitis is a chronic disease is still debated and a consensus is not still reached as demonstrated by differences in the classification of acute recurrent pancreatitis. There is major evidence for considering alcoholic pancreatitis as a chronic disease ab initio while chronic pancreatitis lesions detectable in biliary acute recurrent pancreatitis (ARP) seem a casual association. Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation, hereditary and obstructive pancreatitis seem an acute disease that progress to chronic pancreatitis, likely as a consequence of the activation and proliferation of pancreatic stellate cells that produce and activate collagen and therefore fibrosis. From the diagnostic point of view, in patients with acute recurrent pancreatitis Endoscopic ultrasound (EUS) seems the more reliable technique for an accurate evaluation and follow-up of some ductal and parenchymal abnormalities suspected for early chronic pancreatitis.
Diagnostic criteria for autoimmune pancreatitis in Japan  [cached]
Terumi Kamisawa, Kazuichi Okazaki, Shigeyuki Kawa
World Journal of Gastroenterology , 2008,
Abstract: Autoimmune pancreatitis (AIP) is a particular type of pancreatitis of presumed autoimmune etiology. Currently, AIP should be diagnosed based on combination of clinical, serological, morphological, and histopathological features. When diagnosing AIP, it is most important to differentiate it from pancreatic cancer. Diagnostic criteria for AIP, proposed by the Japan Pancreas Society in 2002 first in the world, were revised in 2006. The criteria are based on the minimum consensus of AIP and aim to avoid misdiagnosing pancreatic cancer as far as possible, but not for screening AIP. The criteria consist of the following radiological, serological, and histopathological items: (1) radiological imaging showing narrowing of the main pancreatic duct and enlargement of the pancreas, which are characteristic of the disease; (2) laboratory data showing abnormally elevated levels of serum γ-globulin, IgG or IgG4, or the presence of autoantibodies; (3) histopathological examination of the pancreas demonstrating marked fibrosis and prominent infiltration of lymphocytes and plasma cells, which is called lymphoplasmacytic sclerosing pancreatitis (LPSP). For a diagnosis of AIP, criterion 1 must be present, together with criterion 2 and/or criterion 3. However, it is necessary to exclude malignant diseases such as pancreatic or biliary cancer.
Capability and Limitations of Recent Diagnostic Criteria for Autoimmune Pancreatitis  [PDF]
Taku Tabata,Terumi Kamisawa,Sawako Kuruma,Kazuro Chiba,Susumu Iwasaki,Go Kuwata,Takashi Fujiwara,Hideto Egashira,Satomi Koizumi,Yuka Endo,Koichi Koizumi,Junko Fujiwara,Takeo Arakawa,Kumiko Momma
International Journal of Rheumatology , 2013, DOI: 10.1155/2013/465428
Abstract: Because a diagnostic serological marker is unavailable, autoimmune pancreatitis (AIP) is diagnosed based on unique features. The diagnostic capabilities and potential limitations of four sets of diagnostic criteria for AIP (Japanese diagnostic criteria 2006 and 2011, Asian diagnostic criteria, and international consensus diagnostic criteria (ICDC)) were compared among 85 patients who were diagnosed AIP according to at least one of the four sets. AIP was diagnosed in 87%, 95%, 95%, and 95% of the patients according to the Japanese 2006, Asian, ICDC, and Japanese 2011 criteria, respectively. The ICDC can diagnose types 1 and 2 AIP independently and show high sensitivity for diagnosis of AIP. However, as the ICDC are rather complex, diagnostic criteria for AIP should perhaps be revised and tailored to each country based on the ICDC. 1. Introduction Autoimmune pancreatitis (AIP) is a specific type of pancreatitis that is thought to have an autoimmune etiology. Since Yoshida et al. [1] proposed AIP as a diagnostic entity in 1995, AIP in various countries, including Japan, has been described. AIP is presently recognized as a pancreatic lesion of IgG4-related disease [2, 3]. Because a diagnostic serological marker is unavailable, it is diagnosed based on unique features. The Japanese diagnostic criteria for AIP were revised in 2006 [4]. The criteria consisted of the following: radiological evidence of pancreatic enlargement and irregular narrowing of the main pancreatic duct; increased serum levels of gammaglobulin, IgG, and IgG4 or the presence of autoantibodies; histological evidence of both lymphoplasmacytic infiltration and fibrosis in the pancreas (Table 1) [4]. Table 1: Japanese clinical diagnostic criteria of AIP 2006 [ 4]. New diagnostic criteria proposed in Korea [5] and the USA [6] during 2006 included response to steroid therapy and other organ involvement (OOI). The Asian diagnostic criteria that included response to steroids as an optional criterion were published in 2008 (Table 2) [7]. Table 2: Asian diagnostic criteria for AIP [ 7]. AIP comprises histological types 1 and 2 [8, 9]. The histological appearance of type 1 AIP, or traditional AIP, is referred to as lymphoplasmacytic sclerosing pancreatitis (LPSP). Type 2 AIP is histologically characterized by neutrophilic infiltration in the epithelium of the pancreatic duct [8–10]. The international consensus diagnostic criteria (ICDC) for AIP were published for worldwide use and independently diagnose both types of AIP [11]. The criteria comprise five cardinal features, and one or more of which in
The role of endoscopic ultrasound (EUS) in relation to other imaging modalities in the differential diagnosis between mass forming chronic pancreatitis, autoimmune pancreatitis and ductal pancreatic adenocarcinoma Papel de la endoscopia en relación con otras modalidades de imagen en el diagnóstico diferencial entre pancreatitis crónica en forma de masa, pancreatitis autoinmune y adenocarcinoma pancreático  [cached]
Julio Iglesias-García,Bj?rn Lindkvist,José Lari?o-Noia,J. Enrique Domínguez-Mu?oz
Revista Espa?ola de Enfermedades Digestivas , 2012,
Abstract: Differential diagnosis of solid pancreatic lesions remains as an important clinical challenge, mainly for the differentiation between mass forming chronic pancreatitis, autoimmune pancreatitis and pancreatic adenocarcinoma. Endoscopic ultrasound (EUS), computed tomography (CT) and magnetic resonance imaging (MRI) can all provide valuable and complementary information in this setting. Among them, EUS has the unique ability to obtain specimens for histopathological diagnosis and can therefore play a crucial role in the evaluation patients with inconclusive findings on initial examinations. Nowadays, new developed techniques associated to EUS, like elastography and contrast enhancement, have shown promising results for the differential diagnosis of these pancreatic lesions. El diagnóstico diferencial de las lesiones sólidas pancreáticas permanece como un reto clínico importante, sobre todo para la diferenciación entre la masa de conformación pancreatitis crónica, pancreatitis autoinmune y el adenocarcinoma de páncreas. Ecografía endoscópica (USE), la tomografía computarizada (TC) y la resonancia magnética (MRI) pueden proporcionar información valiosa y complementaria en este entorno. Entre ellos, la USE tiene la capacidad única de obtener muestras para diagnóstico histopatológico y por lo tanto, puede desempe ar un papel crucial en la evaluación de los pacientes con resultados poco concluyentes en los exámenes iniciales. Hoy en día, las nuevas técnicas desarrolladas asociadas a la USE, como la elastografía y realce de contraste, han mostrado resultados prometedores para el diagnóstico diferencial de las lesiones pancreáticas.
Acute pancreatitis
Bo-Guang Fan,?ke Andrén-Sandberg
North American Journal of Medical Sciences , 2010,
Abstract: Background: Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims: The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods: We reviewed the English-language literature (Medline) addressing pancreatitis. Results: Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions: Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.
EUS and Common bile duct stones
Christine Bergele, M. Giovannini
Annals of Gastroenterology , 2007,
Abstract: SUMMARY Choledocholithiasis is a common disorder, especially in patients older than 60 years, as common bile duct stones may be present in 15% to 60% of cases in this special sample of population. Until recently, endoscopic retrograde cholangiography (ERC), which is a very reliable method for visualizing and extracting gallstones in the same session, was considered the gold-standard for suspected choledocholithiasis; however the not negligible complication rate of diagnostic and therapeutic ERC has led to the evolution of EUS. EUS has proved to be of great sensitivity (up to 97%) for detecting even tiny stones that can easily be masked by contrast medium during ERCP, without any complications related to the procedure, and with a NPV reaching 100%, meaning that it can accurately and safely identify patients with choledocholithiasis and thereby avoid inappropriate instrumental exploration of the duct. Key words: EUS, choledocholithiasis, biliary pancreatitis
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