Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy; Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Italy.
Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy.
Pancreatology. 2024 Sep;24(6):834-839. doi: 10.1016/j.pan.2024.08.001. Epub 2024 Aug 8.
Endoscopic ultrasound (EUS) is the most sensitive method for diagnosing chronic pancreatitis (CP) in its early stages, and Rosemont Classification (RC) is used for its evaluation. Data on the correlation between EUS features and pancreatic exocrine insufficiency (PEI) are limited. We investigated the correlation between the EUS findings and PEI.
This was a retrospective, monocentric cohort study involving patients prospectively enrolled from 2018 to 2022, with definite or probable CP according to the M-ANNHEIM criteria. All the patients underwent EUS and exocrine function investigations within 12 months of diagnosis. PEI was diagnosed using fecal elastase (FE) or when overt steatorrhea was reversed by pancreatic enzyme replacement therapy. Logistic regression analyses, rank correlation, ROC curve, and area under the curve (AUROC) were performed to evaluate the association between EUS features and PEI, and the accuracy of RC in predicting PEI.
Among 128 patients examined (63.3 % male; mean age, 47 years), 69.5 % were diagnosed with PEI. In multivariate logistic regression among all the RC criteria, only lithiasis in the main pancreatic duct (MPD) was associated with increased risk of PEI (OR 2.92, 95 % CI 1.29-6.61; p = 0.01). Rank analysis showed a weak inverse correlation between RC and FE (Spearman's rho = -0.02; p = 0.03). The accuracy of RC was moderate (AUROC 0.62, p = 0.014).
Among RC EUS features, lithiasis in the MPD is helpful for predicting the risk of PEI, while other findings are of limited utility in evaluating exocrine function.
内镜超声（EUS）是诊断早期慢性胰腺炎（CP）最敏感的方法，采用 Rosemont 分类（RC）进行评估。关于 EUS 特征与胰腺外分泌功能不全（PEI）之间相关性的数据有限。我们研究了 EUS 发现与 PEI 之间的相关性。
这是一项回顾性、单中心队列研究，纳入了 2018 年至 2022 年期间前瞻性纳入的患者，根据 M-ANNHEIM 标准明确或可能患有 CP。所有患者在诊断后 12 个月内接受 EUS 和外分泌功能检查。PEI 采用粪便弹性蛋白酶（FE）或胰酶替代治疗逆转明显脂肪泻时诊断。采用逻辑回归分析、秩相关、ROC 曲线和曲线下面积（AUROC）评估 EUS 特征与 PEI 之间的关联，以及 RC 预测 PEI 的准确性。
在 128 例检查患者中（63.3%为男性；平均年龄 47 岁），69.5%被诊断为 PEI。在所有 RC 标准的多变量逻辑回归中，只有主胰管（MPD）结石与 PEI 的风险增加相关（OR 2.92，95%CI 1.29-6.61；p=0.01）。秩分析显示 RC 与 FE 之间呈弱负相关（Spearman's rho=-0.02；p=0.03）。RC 的准确性为中度（AUROC 0.62，p=0.014）。
在 RC EUS 特征中，MPD 结石有助于预测 PEI 的风险，而其他发现对外分泌功能的评估作用有限。
