4559 Long term follow-up of early chronic pancreatitis diagnosed at endoscopic ultrasonography.

Abstract

Aim : The diagnosis of early chronic pancreatitis (ECP) remains difficult and endoscopic ultrasonography (EUS) features are still controversial. The aim of this study was to evaluate the long term follow-up of patients with ECP diagnosed at EUS. Methods : Between 1994 and 1998, 37 patients were diagnosed to have ECP at EUS. All experienced at least one episode of non biliary acute pancreatitis. None had evidence of pancreatic stone on plain film of the abdomen or on CTscanner. The ECP were classified as group A (possible ECP with either parenchymal signs or ductal signs), as group B (probable ECP with both parenchymal and ductal signs) and as group C (certain ECP with pancreatic stones). Results : 11 patients were lost to follow-up, 26 men with median age of 46.5 (23-70) years and median alcohol consumption of 76 ( 0-150) g per day, have been followed for a median duration of 37 (1-94).months. - At the initial examination, 10 patients belonged to group A, 4 to group B and 12 to group C. The pancreatographies (n=24) according to the Cambridge classification were 7 cases in stage 0, 4 cases in stage 1 , 4 cases in stage 2 and 9 cases in stage 3. - At the end of the follow-up, 4 patients underwent surgery (pseudotumorous chronic pancreatitis in 2 cases, duodenal cystic dystrophy in 1 case, and pancreatic cancer complicating chronic pancreatitis in 1 case). 26 patients had clinical evaluation : 12 remained unchanged, 12 had improved health status and 2 still experienced clinical disorders (pain, weight-loss). The final diagnosis of certain ECP was yeldied in 6 out of 10 patients of the group A, in 3 out of 4 patients of the group B and in 9 out of the 12 patients of the group C. Conclusion : The positive predictive value of EUS signs of ECP was 64% in case of possible or probable ECP and 75% in case of certain ECP.