Abstract
Chronic pancreatitis (CP) is associated with a risk of pancreatic cancer and is characterized by irreversible morphological changes, fibrosis, calcification, and exocrine and endocrine insufficiency. CP is a progressive disease with a poor prognosis and is typically diagnosed at an advanced stage. The Japan Pancreas Society proposed criteria for early CP in 2009, and their usefulness has been reported. Recently, a mechanism definition was proposed by the International Consensus Guidelines and early CP was defined as a disease state that is not based on disease duration. CP is diagnosed by computed tomography, magnetic resonance imaging, and endoscopic cholangiopancreatography, which can detect calcification and dilation of the pancreatic ducts; however, detecting early CP with these modalities is difficult because subtle changes in early CP occur before established CP or end-stage CP. Endoscopic ultrasonography (EUS) is useful in the diagnosis of early CP because it allows high-resolution, close-up observation of the pancreas. In addition to imaging findings, EUS with elastography enables measurement of the stiffness of the pancreas, an objective diagnostic measure. Understanding the EUS findings of early CP is important because a histological diagnosis is problematic, and other modalities are not capable of detecting subtle changes in early CP.
Highlights
Chronic pancreatitis (CP) causes irreversible changes such as parenchymal atrophy, fibrosis, and calcification
Endoscopic ultrasonography (EUS) is important for the diagnosis of early CP
Some findings can be detected only by EUS, and its combination with, for instance, elastography and contrast studies will further improve the accuracy of diagnosis of early CP
Summary
Chronic pancreatitis (CP) causes irreversible changes such as parenchymal atrophy, fibrosis, and calcification. CP is diagnosed by the presence of stones in the pancreatic ducts or calcifications throughout the pancreas by computed tomography (CT), X-ray, or abdominal ultrasonography (AUS). The Cambridge classification [8] incorporated CT, AUS and ERCP features to classify and grade disease severity These diagnostic modalities accurately identify patients without pancreatic pathologic conditions and those with severe CP. As observed using EUS, is classified based on the number of positive findings, and advanced CP with calcification can be classified as mild depending on the number of findings. This could result in a discrepancy between clinical progression and the EUS severity classification [12]. The Rosemont criteria (RC) were published in 2009 [13] (Table 1)
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