Symposium 3. Chronic pancreatitis: current problems of the diagnostic criteria

Abstract

criteria for chronic pancreatitis currently used in Japan were proposed by the Japan Pancreas Society (JPS) in 1995 (JPS Criteria 1995),5,6 with a small revision to include magnetic resonance cholangiopancreatography fi ndings in 2001 (JPS Criteria 2001).7,8 The fi rst Marseilles symposium of 1963 classifi ed pancreatitis into four main groups: (1) acute pancreatitis, (2) relapsing acute pancreatitis with clinical biological restitution of the gland, (3) chronic relapsing pancreatitis with acute exacerbation, and (4) chronic pancreatitis with anatomical and/or functional residual damage to the gland.9 The defi nition of chronic pancreatitis is based on the persistence of lesions. The Cambridge classifi cation of 1983 provided a grading and severity system using imaging tests.3,10 The second Marseilles symposium of 19842 clinically characterized chronic pancreatitis as recurrent or persisting abdominal pain along with pancreatic insuffi ciency indicated by steatorrhea or diabetes, and morphologically characterized it as irregular sclerosis with destruction and permanent loss of exocrine parenchyma and varying degrees of dilatation of the duct system. The most recent Marseilles–Rome classifi cation of 19884 classifi ed chronic pancreatitis into three groups; (1) chronic obstructive pancreatitis; (2) chronic calcifying pancreatitis, which is characterized by the presence of intraductal protein precipitates or plugs and calcifi ed precipitates (calculi or stones); and (3) chronic infl ammatory pancreatitis, which is characterized by the loss of exocrine parenchyma replaced by a dense fi brosis infi ltrated by mononuclear cells. Despite these international expert meetings in the past 40 years, there is no consensus on the classifi cation of chronic pancreatitis because many data on the diagnosis and treatment of chronic pancreatitis from different centers are hard to compare, except those data on patients with advanced chronic pancreatitis. The JPS Criteria of 1995 and 2001 classifi ed chronic pancreatitis into (1) defi nite, (2) probable, and (3) possible chronic pancreatitis.11 The criteria can be applied