Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
Division of Digestive Disease, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, United States.
World J Gastroenterol. 2021 Nov 14;27(42):7376-7386. doi: 10.3748/wjg.v27.i42.7376.
Few studies have fully described endoscopic ultrasound (EUS) features of newly diagnosed autoimmune pancreatitis (AIP) involving both typical findings and chronic pancreatitis (CP) features. The typical EUS findings are prevalent in the diffuse type AIP but may not be as common for the focal type, and the differences between the diffuse and focal AIP need to be specified.
To demonstrate the EUS features of newly diagnosed AIP and the difference between diffuse and focal AIP.
This retrospective single center study included 285 patients of newly diagnosed type 1 AIP following the international consensus diagnostic criteria, with the EUS procedures accomplished before corticosteroid initiation. We explored the EUS features and compared the typical AIP and CP features between the diffuse and focal AIP cases. The Rosemont criteria were employed for CP features definition and CP change level comparison.
For the typical AIP features, there were significantly more patients in the diffuse group with bile duct wall thickening (158 of 214 cases, 73.4% 37 of 71 cases, 52.1%, 0.001) and peripancreatic hypoechoic margin (76 of 214 cases, 35.5% 5 of 71 cases, 7.0%, 0.001). For the CP features, there were significantly more patients in the focal group with main pancreatic duct dilation (30 of 214 cases, 14.0% 18 of 71 cases, 25.3%, 0.03). The cholangitis-like changes were more prevalent in the focal cases with pancreatic head involvement. The CP change level was relatively limited for newly diagnosed AIP cases in both groups.
This study demonstrated the difference in the typical AIP and CP features between diffuse and focal AIP and indicated the limited CP change level in newly diagnosed AIP.
很少有研究全面描述新诊断的自身免疫性胰腺炎（AIP）的内镜超声（EUS）特征，包括典型表现和慢性胰腺炎（CP）特征。弥漫型 AIP 中常见典型 EUS 表现，但局灶型可能不常见，且弥漫型和局灶型 AIP 之间的差异需要明确。
展示新诊断的 AIP 的 EUS 特征以及弥漫型和局灶型 AIP 之间的差异。
本回顾性单中心研究纳入了 285 例根据国际共识诊断标准诊断的新发 1 型 AIP 患者，在开始皮质类固醇治疗前进行 EUS 检查。我们探讨了 EUS 特征，并比较了弥漫型和局灶型 AIP 患者的典型 AIP 和 CP 特征。采用 Rosemont 标准定义 CP 特征，并比较 CP 改变程度。
对于典型 AIP 特征，弥漫型患者胆管壁增厚（158/214 例，73.4% 37/71 例，52.1%， 0.001）和胰周低回声边界（76/214 例，35.5% 5/71 例，7.0%， 0.001）的患者明显更多。对于 CP 特征，局灶型患者主胰管扩张（30/214 例，14.0% 18/71 例，25.3%， 0.03）的患者更多。胰头受累的局灶型病例更常见胆管炎样改变。两组新诊断的 AIP 患者的 CP 改变程度均相对有限。
本研究显示了弥漫型和局灶型 AIP 之间在典型 AIP 和 CP 特征上的差异，并表明新诊断的 AIP 中 CP 改变程度有限。
