Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Gut. 2011 May;60(5):666-70. doi: 10.1136/gut.2010.207951. Epub 2010 Dec 3.
Characteristic pancreatic duct changes on endoscopic retrograde pancreatography (ERP) have been described in autoimmune pancreatitis (AIP). The performance characteristics of ERP to diagnose AIP were determined.
The study was done in two phases. In phase I, 21 physicians from four centres in Asia, Europe and the USA, unaware of the clinical data or diagnoses, reviewed 40 preselected ERPs of patients with AIP (n=20), chronic pancreatitis (n=10) and pancreatic cancer (n=10). Physicians noted the presence or absence of key pancreatographic features and ranked the diagnostic possibilities. For phase II, a teaching module was created based on features found most useful in the diagnosis of AIP by the four best performing physicians in phase I. After a washout period of 3 months, all physicians reviewed the teaching module and reanalysed the same set of ERPs, unaware of their performance in phase I.
In phase I the sensitivity, specificity and interobserver agreement of ERP alone to diagnose AIP were 44, 92 and 0.23, respectively. The four key features of AIP identified in phase I were (i) long (>1/3 the length of the pancreatic duct) stricture; (ii) lack of upstream dilatation from the stricture (<5 mm); (iii) multiple strictures; and (iv) side branches arising from a strictured segment. In phase II the sensitivity (71%) of ERP significantly improved (p<0.05) without a significant decline in specificity (83%) (p>0.05); the interobserver agreement was fair (0.40).
The ability to diagnose AIP based on ERP features alone is limited but can be improved with knowledge of some key features.
内镜逆行胰胆管造影术（ERP）上胰腺导管的特征性改变已在自身免疫性胰腺炎（AIP）中描述过。本研究旨在确定 ERP 诊断 AIP 的性能特征。
本研究分两个阶段进行。在第一阶段，来自亚洲、欧洲和美国的四个中心的 21 名医生在不了解临床数据或诊断的情况下，对 40 例经选择的 AIP（n=20）、慢性胰腺炎（n=10）和胰腺癌（n=10）患者的 ERP 进行了回顾性分析。医生们记录了关键胰管特征的存在或缺失，并对诊断可能性进行了排序。在第二阶段，根据在第一阶段表现最好的四位医生发现的对 AIP 最有用的特征，创建了一个教学模块。在 3 个月的洗脱期后，所有医生都查看了教学模块并重新分析了同一组 ERP，而不知道他们在第一阶段的表现。
在第一阶段，ERP 单独诊断 AIP 的敏感性、特异性和观察者间一致性分别为 44%、92%和 0.23。在第一阶段确定的 AIP 的四个关键特征是：（i）长（>胰管长度的 1/3）狭窄；（ii）狭窄处无上游扩张（<5mm）；（iii）多处狭窄；和（iv）分支从狭窄段发出。在第二阶段，ERP 的敏感性（71%）显著提高（p<0.05），而特异性（83%）无显著下降（p>0.05）；观察者间一致性为中等（0.40）。
仅凭 ERP 特征诊断 AIP 的能力有限，但通过了解一些关键特征可以提高诊断能力。
