Correlation of Histologic Findings After Surgery and Preoperative EUS Features in Advanced Chronic Pancreatitis

Abstract

Correlation of Histologic Findings After Surgery and Preoperative EUS Features in Advanced Chronic Pancreatitis Djuna L. Cahen, Johan A. Offerhaus, Paul Fockens, Dirk J. Gouma, Marco J. Bruno Introduction: Diagnosing chronic pancreatitis (CP) can be a challenge, specifically in patients with pancreatic pain and early disease. Endoscopic ultrasonography (EUS) is considered to reveal abnormalities when other tests are normal. Nine EUS criteria have been established to assess ductal and parenchymal morphology. The aim of this prospective study is to evaluate if the extent of inflammatory and fibrotic changes found at histology correlate with EUS findings in patients with advanced CP. Materials and methods: Patients were recruited from the CEPAN study; a randomized controlled trial comparing endoscopic and surgical drainage of the pancreatic duct in patients with CP. Within 3 days before pancreaticojejunostomy (during which histologic specimens were obtained from the head, corpus and tail area), an EUS was performed. Assessed were the established EUS criteria for CP which are considered to correspond with inflammation and fibrosis (hyperechoic strands, hyperechoic foci, lobularity and hyperechoic duct walls), in addition to atrophy. Findings of these 5 features were combined into a single score to rank disease severity. Histologic specimens were evaluated by a pathologist, blinded to EUS findings, and scored according to presence of inflammation and fibrosis. By each modality, patients were ranked according to disease severity from most severe (1) too least severe (6). Results: Six CP patients were included until November 2004, with a median disease duration of 30 months from clinical diagnosis. Three patients had exocrine insufficiency and one patient suffered from endocrine insufficiency. In Figure 1 the two rankings according to severity of CP are visualized. Although correspondence is not complete, it is apparent that the rankings by EUS and histology are not randomly distributed; the 3 patients scored as most severe according to histologic findings, were also in the top 3 patients according to EUS outcome. Conclusions: Although numbers are still small, these data suggest that the extent of inflammatory and fibrotic changes observed in histologic specimens of CP patients correlate with EUS findings.