Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, USA.
Department of Gastroenterology, Endocrinology and Metabolism, University Hospital, Philipps-Universität Marburg, Marburg, Germany.
Pancreatology. 2020 Jul;20(5):822-827. doi: 10.1016/j.pan.2020.05.025. Epub 2020 Jun 18.
Chronic pancreatitis (CP) is a complex inflammatory disease with variable presentations and outcomes. This statement is part of the international consensus guidelines on CP, specifically on the diagnostic role of endoscopic ultrasound (EUS).
An international working group with experts on the role of diagnostic EUS in the management of CP from the major pancreas societies (IAP, APA, JPS, and EPC) evaluated two key statements generated from evidence on two questions deemed to be the most clinically relevant. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the level of evidence available for each statement. To determine the level of agreement, the working group voted on each statement for strength of agreement, using a nine-point Likert scale in order to calculate Cronbach's alpha reliability coefficient.
Strong consensus was obtained for both of the following statements [1]. The ideal threshold number of EUS criteria necessary to diagnose CP has not been firmly established, but the presence of 5 or more and 2 or less strongly suggests or refutes the diagnosis, respectively. The Rosemont scoring system standardizes the reporting of EUS signs indicative of chronic pancreatitis, but further studies are needed to demonstrate an overall improvement of its diagnostic accuracy over conventional scoring [2]. Specificity, inter- and intra-observer variability and pre-test probability limit the reliability and utility of EUS to help diagnose CP especially early stages of the disease.
The presence of 5 or more and 2 or less EUS criteria strongly suggests or refutes the diagnosis of CP, respectively. Intra-observer variability still limits the role of EUS in diagnosing CP especially early stage disease.
慢性胰腺炎（CP）是一种具有多种表现和结局的复杂炎症性疾病。这一陈述是 CP 国际共识指南的一部分，特别是关于内镜超声（EUS）的诊断作用。
一个由来自主要胰腺学会（IAP、APA、JPS 和 EPC）的具有 EUS 在 CP 管理中诊断作用专业知识的国际工作组，评估了从两个被认为最具临床相关性的问题的证据中生成的两个关键陈述。采用推荐评估、制定与评价（GRADE）方法来评估每个陈述的证据水平。为了确定一致性水平，工作组对每个陈述的同意程度进行了投票，使用九点李克特量表进行投票，以计算 Cronbach's alpha 可靠性系数。
以下两个陈述[1]均达成了强烈共识。尚未确定诊断 CP 所需的 EUS 标准的理想阈值数量，但存在 5 个或更多和 2 个或更少的标准分别强烈提示或排除诊断。Rosemont 评分系统标准化了提示慢性胰腺炎的 EUS 征象的报告，但需要进一步的研究来证明其总体诊断准确性优于传统评分[2]。特异性、观察者内和观察者间变异性以及术前概率限制了 EUS 诊断 CP 的可靠性和实用性，尤其是在疾病的早期阶段。
存在 5 个或更多和 2 个或更少的 EUS 标准分别强烈提示或排除 CP 的诊断。观察者内变异性仍然限制了 EUS 在诊断 CP 中的作用，尤其是在早期疾病阶段。
