High Incidence of Early Chronic Pancreatitis Changes in Patients Undergoing EUS for a Non-Pancreaticobiliary Indication

Abstract

Introduction: The application of endoscopic ultrasound (EUS) criteria for chronic pancreatitis (CP) may be problematic in clinical practice since the prevalence of parenchymal/ductal changes is unknown in patients without abdominal pain or risk factors for CP. Autopsy data demonstrate a high prevalence of CP changes in patients without an overt history of pancreatic disease. The aim of this study is to define the prevalence of pancreatic parenchymal changes by the Rosemont classification in patients without symptoms/signs of chronic pancreatitis.Table 1: Criteria for Chronic Pancreatitis Based on Rosemont CriteriaMethods: A prospective study at a single tertiary-care center was performed. 100 consecutive patients undergoing EUS for a non-pancreatico-biliary indication were eligible. Prior to EUS, patients completed a questionnaire detailing smoking, alcohol/drug use, presence/severity of abdominal pain and sequelae of CP (weight loss, loose stool and diabetes). Immediately after EUS, findings based on the Rosemont classification were recorded. Diagnostic accuracy was calculated and Chi-Square test/t-test were used for intergroup comparisons. Results: 100 patients were enrolled (58 male (58%), mean age 63 +/- 12.9 years). Eighty patients (80%) had no abdominal pain, 29 (29%) use alcohol, 26 (26%) were active smokers and 36 (36%) were former smokers. EUS indications were gastric lesions/cancer staging (27), duodenal lesions (10), esophageal lesions/cancer staging (42), abdominal pain (4), lymphadenopathy (3), liver lesions (6), surveillance of malignancy (2) abnormal gastric thickening (3), family history of malignancy (2) and pyloric stenosis (1). One patient had a Major A criteria (1%), 8 had major B criteria (8%) and 42 (42%) had at least one minor criteria. Overall 42 patients (42%) had a single criteria for the EUS diagnosis of CP by the Rosemont Criteria (table 1). No patients met Rosemont criteria for consistent with CP, 5 were suggestive of CP (5%) and 14 (14%) were indeterminate for CP. There was no association between history of smoking, active smoking, alcohol use, abdominal pain, loose stool, weight loss or age (all p > 0.05) with any EUS diagnosis of CP based on Rosemont criteria. Conclusion: The high proportion of patients who present for non-pancreatico-biliary EUS who demonstrate EUS criteria for CP would indicate that these findings should be interpreted with caution in patients without symptoms or risk factors for CP. It appears as though some EUS criteria for CP may be normal age- or environmental-related changes and not specific for CP.