Catalano M F, Lahoti S, Geenen J E, Hogan W J
St. Luke's Medical Center, Pancreatic Biliary Center, Milwaukee, Wisconsin, USA.
Gastrointest Endosc. 1998 Jul;48(1):11-7. doi: 10.1016/s0016-5107(98)70122-1.
Chronic pancreatitis in its early stages may defy diagnosis despite existing diagnostic modalities. Endoscopic retrograde pancreatography (ERCP), secretin test, and conventional ultrasound are insensitive in detecting the early stages of chronic pancreatitis. The aim of this study was to determine whether endoscopic ultrasonography (EUS) high-resolution imaging allows for the detection of chronic pancreatitis as compared with clinical history, ERCP, and secretin test.
Eighty consecutive patients with recurrent pancreatitis underwent ERCP, EUS, and secretin test. EUS evaluated parenchymal changes: echogenic foci (calcification), prominent interlobular septae (fibrosis), small cystic cavities (edema), lobulated outer gland margin (fibrosis/atrophy), and heterogeneous parenchyma; and ductal changes: dilation, irregularity, echogenic wall (fibrosis), side-branch ectasia, and echogenic foci (stones). EUS criteria for chronic pancreatitis included mild (1 to 2 features), moderate (3 to 5 features), and severe (more than 5 features).
Abnormal studies were EUS = 63, ERCP = 36, and secretin test = 25. Secretin test had 100% agreement with normal and severe chronic pancreatitis by EUS criteria, but agreement was poor for mild (13%) and moderate (50%) disease. Alternatively, the agreement between ERCP- and EUS-specific criteria was excellent for normal (100%), moderate (92%), and severe (100%) chronic pancreatitis and poor for mild (17%) disease. When the 2-test modality (ERCP and secretin test) was compared with EUS alone, no enhancement in agreement was seen.
Using the above criteria EUS may assist in the diagnosis of chronic pancreatitis not established by ERCP or secretin test. Excellent agreement can be expected between EUS and ERCP in the diagnosis of chronic pancreatitis with the exception of mild changes noted on EUS (kappa statistics = 0.82: 95% CI [0.70, 0.95]). Long-term follow-up of the patients with mild EUS changes will determine the validity of EUS in diagnosing the early stages of chronic pancreatitis.
慢性胰腺炎在早期阶段可能难以诊断，尽管现有多种诊断方法。内镜逆行胰胆管造影（ERCP）、胰泌素试验和传统超声在检测慢性胰腺炎早期阶段时并不敏感。本研究的目的是确定与临床病史、ERCP和胰泌素试验相比，内镜超声（EUS）高分辨率成像是否能够检测出慢性胰腺炎。
连续80例复发性胰腺炎患者接受了ERCP、EUS和胰泌素试验。EUS评估实质改变：回声灶（钙化）、小叶间隔增宽（纤维化）、小囊腔（水肿）、腺体边缘分叶状（纤维化/萎缩）和实质不均质；以及导管改变：扩张、不规则、回声壁（纤维化）、侧支扩张和回声灶（结石）。慢性胰腺炎的EUS标准包括轻度（1至2项特征）、中度（3至5项特征）和重度（超过5项特征）。
检查异常的情况为：EUS = 63例，ERCP = 36例，胰泌素试验 = 25例。根据EUS标准，胰泌素试验与正常和重度慢性胰腺炎的一致性为100%，但与轻度（13%）和中度（50%）疾病的一致性较差。另外，ERCP和EUS特定标准之间对于正常（100%）、中度（92%）和重度（100%）慢性胰腺炎的一致性极佳，而对于轻度（17%）疾病的一致性较差。当将两项检查方法（ERCP和胰泌素试验）与单独的EUS进行比较时，未发现一致性有提高。
采用上述标准，EUS可能有助于诊断ERCP或胰泌素试验未确诊的慢性胰腺炎。在慢性胰腺炎的诊断中，除了EUS上发现的轻度改变外，EUS和ERCP之间有望达成极佳的一致性（kappa统计量 = 0.82：95%可信区间[0.70, 0.95]）。对EUS有轻度改变的患者进行长期随访将确定EUS在诊断慢性胰腺炎早期阶段的有效性。
