Endoscopic ultrasound for the diagnosis of chronic pancreatitis

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.

Figures

Figure 1

The normal endosonographic appearance of the pancreas. A: View of pancreatic body from gastric station. The parenchyma is homogeneous and granular (“salt and pepper”). The duct is neither dilated nor ectatic; B: Dorsal ventral anlage. The ventral pancreas is relatively echogenic compared with the dorsal pancreas. There is a distinct border between the dorsal and ventral pancreas.

Figure 2

Examples of endoscopic ultrasound (EUS) chronic pancreatitis (CP) criteria. A: Hyperechoic duct wall (arrow); B: Cyst (arrow); C: Hyperechoic strands (arrows); D: Visible side-branch (arrow); E: Dilated and irregular main pancreatic duct with visible side-branches (arrow); F: Hyperechoic foci (arrows).

Figure 3

Examples of EUS CP criteria. A: Dilated main pancreatic duct (arrow); B: Parenchymal calcifications (arrows); C: Main duct calcifications (arrows); D: Lobules (arrows); E: Stranding (arrows); F: Irregular main pancreatic duct (arrow).