4568 Endoscopic ultrasound criteria for chronic pancreatitis in a group of asymptomatic patients: preliminary results of a survey from a country with low prevalence of chronic pancreatitis.

Abstract

BACKGROUND: Endoscopic ultrasound (EUS) has been established as the most sensitive imaging method for the diagnosis of chronic pancreatitis (CP), specially early or subtle cases. Prevalence varies with the subgroup studied such as abdominal pain/dyspepsia; however in some of these patients, a possible bias exists.We aimed to study a group of patients without these symptoms and no history or suspicion of pancreatic disease; furthermore in a country (Mexico) with a low prevalence of chronic pancreatitis. MATERIAL & METHODS: All patients sent to our institution for EUS for reasons other than abdominal pain or suspected pancreatic disease, were included. Those patients with biliary disease or pancreatic/ampulla neoplasms were excluded. CP was diagnosed when at least 3 established criteria by EUS were found. EUS procedures were performed using a Pentax FG32UA linear array echoendoscope coupled to a Hitachi EUB 515 console. RESULTS:We have included 82 patients with a mean age of 49 years (16-82); 53 male and 29 female. Common diagnoses for EUS referral were: portal hypertension, submucosal tumors or esophageal/gastric cancer staging. Nineteen patients (23%)had at least one criteria, as follows: hyperecoic duct walls: 9, parenchymal heterogeneity: 2 (1 alcoholic), lobularity: 1. Two criteria were present in 4: parenchymal heterogeneity and hyperecoic duct walls in all 4. More than 3 criteria: 3 patients (1 alcoholic). So, for these group of patients with no symptoms attributable to pancreatic disease, CP was established by EUS in 3/82 (0.04%). CONCLUSIONS: EUS criteria suggestive of CP are infrequent in asymptomatic patients. In some of these cases alcoholism is present and could explain the imaging findings, but others cannot be explained by this. It is possible that other factors, such as obesity, age or weight loss could explain the findings in some patients. Incidentally we found that using the Pentax echoendoscope, pancreatic duct wall heterogeneity was not rare (15%). Finally, the low prevalence that we found could support that EUS diagosis of CP is indeed related to symptoms such as abdominal pain/dyspepsia. In any case we continue our study to establish diagnostic value (Sens, spec, PPV, NPV) in a group with a low pre-test probability of disease.