Defining the endoscopic ultrasound features of chronic pancreatitis in Asians: a multicenter validation study

Background Although endoscopic ultrasound (EUS) features and criteria have been described in chronic pancreatitis, challenges remain with interoperator variability and ease of adoption. The aim of this study was to define and validate the EUS features of chronic pancreatitis in a multicenter prospective study in Asia. Method The study was divided into two parts: the first part was conducted to derive the EUS features of chronic pancreatitis with adequate interoperator agreement; the second was to prospectively evaluate these features in a multicenter cross-sectional study and determine the optimal combination of features for the diagnosis of chronic pancreatitis. Prospectively enrolled cases had standard internationally validated radiologic or histologic features of chronic pancreatitis, and controls were patients without chronic pancreatitis who underwent EUS examination. Results The top six EUS features that had good interobserver agreement (mean kappa 0.73, range 0.60 – 0.90) were selected to be further evaluated in part II of the study. These included: hyperechoic foci with shadowing, lobularity with honeycombing, cysts, dilated main pancreatic duct, dilated side branches, and calculi in the main pancreatic duct. A total of 284 subjects (132 cases, 152 controls) were enrolled from 12 centers in Asia. All six features had high accuracy ranging from 63.3 % to 89.1 %. Two or more of these six EUS features accurately defined chronic pancreatitis (sensitivity 94.7 %, specificity 98.0 %), with an area under the receiver operating curve of 0.986. Conclusion This multicenter Asian study characterized and defined the EUS features of chronic pancreatitis. This provides a useful tool in clinical practice and further research in pancreatic cancer surveillance.

Download Full-text

THE ROLE OF ENDOSCOPIC ULTRASOUND IN DIAGNOSIS OF CHRONIC PANCREATITIS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.2.3 ◽

2018 ◽

pp. 20-26

Author(s):

Van Huy Tran ◽

Trung Nam Phan ◽

Khanh Vinh

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Endoscopic Ultrasound ◽

Main Pancreatic Duct ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Endoscopy Ultrasound ◽

Pancreatic Duct Stone

Background and aims: To evaluate the efficacy of endoscopic ultrasound for diagnosis chronic pancreatitis by Rosemont classification. Patients and methods: A cross – sectional study was conducted on patients undergoing endoscopy ultrasound to diagnose chronic pancreatitis. Results: Study on a total of 57 patients indicated for endoscopic ultrasound. We have some following results: The lesions of chronic pancreatitis on endoscopic ultrasound: The hyperechoic foci without shadowing and stranding is 82.5% and hyperechoic foci with shadowing is 70.2%, cyst and pseudocyst are about 15.8%. Main pancreatic duct dilation is 71.9%, hyperechoic main pancreatic duct wall is 70.2%, main pancreatic duct stone is about 45.6%. Rosemont classification in diagnosis of chronic pancreatitis: Consistent with chronic pancreatitis by 1 major A feature (+) ≥ 3 minor features is 69.4% and 2 major A features is 30,6%. Suggestive of chronic pancreatitis by over 5 minor features is 100%. EUS is more accurate than CT in detecting early chronic pancreatitis. Conclusions:Endoscopic ultrasound is a highly effective method of diagnosing chronic pancreatitis. Key words: chronic pancreatitis, endoscopic ultrasound

Download Full-text

THE PRIMARY RESEARCH: THE ROLE OF ENDOSCOPIC ULTRASOUND IN DIAGNOSIS OF CHRONIC PANCREATITIS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.5.4 ◽

2017 ◽

pp. 40-47

Author(s):

Khanh Vinh ◽

Van Huy Tran

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Endoscopic Ultrasound ◽

Main Pancreatic Duct ◽

Cross Sectional Study ◽

Primary Research ◽

Cross Sectional ◽

Endoscopy Ultrasound ◽

Pancreatic Duct Stone

Background and aims: To evaluate the efficacy of endoscopy ultrasound for diagnosis chronic pancreatitis by Rosemont classification. Patients and methods: A cross - sectional study was conducted on 44 patients undergoing endoscopy ultrasound to diagnose chronic pancreatitis. Results: Study on a total of 44 patients indicated for endoscopic ultrasound. We have some following results: The lesions of chronic pancreatitis on endoscopic ultrasound: The hyperechoic foci without shadowing and stranding was 79.5% and hyperechoic foci with shadowing was 72.7%, cyst and pseudocyst were about 13.6%. Main pancreatic duct dilation is 75%, hyperechoic main pancreatic duct wall was 72.7%, main pancreatic duct stone and irregular main pancreatic duct contour were about 52.2%. Rosemont classification in diagnosis of chronic pancreatitis: Consistent with chronic pancreatitis by 1 major A feature (+) ≥ 3 minor features is 67.5% and 2 major A features is 32.5%. Suggestive of chronic pancreatitis by over 5 minor features is 100%. EUS is more accurate than CT in detecting early chronic pancreatitis. Conclusions: Endoscopic ultrasound is a highly effective method of diagnosing chronic pancreatitis. Key words: endoscopy ultrasound, chronic pancreatitis

Download Full-text

Endoscopic Ultrasound Findings in Patients Diagnosed with Exocrine Pancreatic Insufficiency by Low Fecal Elastase-1

Gastroenterology Research and Practice ◽

10.1155/2019/5290642 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Mazen Shobassy ◽

Nedaa Husainat ◽

Abdalaziz Tabash ◽

Kalpesh Patel ◽

Hashem B. El-Serag ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Endoscopic Ultrasound ◽

Pancreatic Insufficiency ◽

Cross Sectional Study ◽

Lifestyle Factors ◽

Exocrine Pancreatic Insufficiency ◽

Cross Sectional ◽

Fecal Elastase ◽

Elastase 1 ◽

Pancreatic Neoplasia

Background and Aims. Fecal elastase-1 (FE-1) as a screening test for exocrine pancreatic insufficiency (EPI) is gaining popularity in clinical practice. The role of imaging in patients with FE-1-related suspicion of EPI remains unclear. The aim of this study was to characterize endoscopic ultrasound (EUS) findings for patients with low FE-1. Methods. A retrospective cross-sectional study was performed in 40 patients who had low FE-1 and underwent EUS to evaluate the pancreas. We obtained data on demographic and lifestyle factors, EUS findings, and histopathology results. We compared these variables between patients with FE‐1<100 mcg/g vs. 100-200 mcg/g. Results. Most patients (82.5%) established one or more new diagnoses from EUS. Diagnoses included: definitive chronic pancreatitis (n=29, 72.5%), fatty pancreas (n=9, 22.5%), and pancreatic solid mass or cyst (n=9, 22.5%). Half (n=4) of the solid or cystic lesions were neoplastic. All patients with a solid pancreatic mass also had concurrent chronic pancreatitis. There were no significant differences in EUS findings or demographic or lifestyle factors between groups with FE‐1<100 mcg/g vs. 100-200 mcg/g. Conclusion. Chronic pancreatitis is the most common EUS finding in patients with low FE-1 levels. EUS appears helpful in determining the cause of EPI in most patients with low FE-1 and may detect unsuspected pancreatic neoplasia.

Download Full-text

Extracorporeal rendezvous technique combining endoscopic retrograde pancreatography with endoscopic ultrasound for main pancreatic duct disconnection arising from acute necrotizing pancreatitis: a case report

VideoGIE ◽

10.1016/j.vgie.2021.07.001 ◽

2021 ◽

Author(s):

Toshiyasu Shiratori ◽

So Nakaji ◽

Shigenobu Yoshimura ◽

Natsuki Kawamitsu ◽

Shin Inoue

Keyword(s):

Case Report ◽

Pancreatic Duct ◽

Endoscopic Ultrasound ◽

Main Pancreatic Duct ◽

Necrotizing Pancreatitis ◽

Acute Necrotizing Pancreatitis ◽

Endoscopic Retrograde Pancreatography ◽

Endoscopic Retrograde ◽

Rendezvous Technique ◽

Acute Necrotizing

Download Full-text

Splenic artery pseudoaneurysm and resultant haematosuccus pancreaticus

BMJ Case Reports ◽

10.1136/bcr-2020-239485 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239485

Author(s):

Shwetambari Sonanis ◽

Benjamin Layton ◽

Oliver Nicholson ◽

DA Subar

Keyword(s):

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Splenic Artery ◽

Clinical Symptoms ◽

Cross Sectional ◽

Artery Pseudoaneurysm ◽

Risk Of Rupture ◽

Cross Sectional Imaging ◽

Sectional Imaging ◽

Splenic Artery Pseudoaneurysm

Splenic artery pseudoaneurysm (SAP) is a rare and dangerous diagnosis with a high risk of rupture and death. It is the most common cause of main pancreatic duct haematoma—haematosuccus pancreaticus (HP). Neither SAP nor HP have specific clinical features that allow diagnosis without cross-sectional imaging. Upper gastrointestinal haemorrhage and a history of pancreatitis should raise clinical suspicion but ultimately endoscopy and CT are required. We report a case of a 51-year-old man without clinical symptoms in whom cross-sectional imaging was undertaken for incidental severe acute anaemia. This demonstrated stigmata of chronic pancreatitis and the main pancreatic duct was distended with dense material in keeping with haematoma. The diagnosis of a SAP bleeding into the main pancreatic duct was made radiologically. A subsequent oesophago-gastro-duodenoscopy confirmed the diagnosis. The imaging appearances, pathophysiology and management are discussed.

Download Full-text

Clinical profile of patients with pancreatitis

International Surgery Journal ◽

10.18203/2349-2902.isj20164702 ◽

2017 ◽

Vol 4 (2) ◽

pp. 534

Author(s):

MD. Shakeel ◽

Syed Shahid Irfan

Keyword(s):

Acute Pancreatitis ◽

Chronic Pancreatitis ◽

Dietary Habits ◽

Necrotizing Pancreatitis ◽

Cross Sectional Study ◽

Cross Sectional ◽

Common Diagnosis ◽

History Of ◽

In The Beginning ◽

Alcoholic Liver Diseases

Background: Pancreatitis is an inflammatory process leading to abdominal pain, progressive destruction of the exocrine tissue and in some patients a loss of endocrine tissue as well. However owing to the tremendous reserve of pancreatic function, insufficiency may be at subclinical at least in the beginning of the disease.Methods: A cross sectional study was conducted which included the patients admitted with pancreatitis. For all the patients, meticulous records will be maintained regarding clinical features, family history of pancreatitis, alcohol intake, dietary habits, and stigmata of alcoholic liver diseases and by performing various investigations. 200 cases admitted, diagnosed to have pancreatitis.Results: The most common diagnosis was acute pancreatitis (48%) followed by chronic pancreatitis (12%), acute pancreatitis and pseudocyst (12%), acute on chronic pancreatitis (12%), necrotizing pancreatitis (8%) and acute pancreatitis with others (8%).Conclusions: Overall acute pancreatitis constituted 76%, chronic pancreatitis 12% and acute on chronic pancreatitis 12%.

Download Full-text

Clinical Study of Chronic Pancreatitis with Focal Irregular Narrowing of the Main Pancreatic Duct and Mass Formation: Comparison with Chronic Pancreatitis Showing Diffuse Irregular Narrowing of the Main Pancreatic Duct

Pancreas ◽

10.1097/00006676-200210000-00011 ◽

2002 ◽

Vol 25 (3) ◽

pp. 283-289 ◽

Cited By ~ 51

Author(s):

Tokio Wakabayashi ◽

Yukimitsu Kawaura ◽

Yoshitake Satomura ◽

Tomoharu Fujii ◽

Yoshiharu Motoo ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Clinical Study ◽

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Mass Formation

Download Full-text

Validity of four clinical prediction scores for pulmonary embolism in a sub-Saharan African setting: a protocol for a Cameroonian multicentre cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-031322 ◽

2019 ◽

Vol 9 (10) ◽

pp. e031322

Author(s):

Agnès Esiéné ◽

Paul Owono Etoundi ◽

Joel Noutakdie Tochie ◽

Junette Arlette Mbengono Metogo ◽

Jacqueline Ze Minkande

Keyword(s):

Pulmonary Embolism ◽

Emergency Departments ◽

Diagnostic Performance ◽

Cross Sectional Study ◽

Sub Saharan Africa ◽

Receiver Operating Curve ◽

Clinical Prediction ◽

Sectional Study ◽

Cross Sectional ◽

Sub Saharan

IntroductionPulmonary embolism poses one of the most challenging diagnoses in medicine. Resolving these diagnostic difficulties is more crucial in emergency departments where fast and accurate decisions are needed for a life-saving purpose. Here, clinical pretest evaluation is an important step in the diagnostic algorithm of pulmonary embolism. Although clinical probability scores are widely used in emergency departments of sub-Saharan Africa, no study has cited their diagnostic performance in this resource-constrained environment. This study will seek to assess the performance of four routinely used clinical prediction models in Cameroonians presenting with suspicion of pulmonary embolism at the emergency department.Methods and analysisIt will be a cross-sectional study comparing the sensitivity, specificity, positive and negative predictive values and accuracy of the Wells, Simplified Wells, Revised Geneva and the Simplified Revised Geneva Scores to CT pulmonary angiography as gold standard in all consecutive consenting patients aged above 15 years admitted for clinical suspicion of pulmonary embolism to the emergency departments of seven major referral hospitals of Cameroon between 1 July 2019 and 31 December 2020. The area under the receiver operating curve, calibration plots, Hosmer and Lemeshow statistics, observed/expected event rates, net benefit and decision curve will be measured of each the clinical prediction test to ascertain the clinical score with the best diagnostic performance.Ethics and disseminationClearance has been obtained from the Institutional Review Board of the Faculty of medicine and biomedical sciences of the University of Yaounde I, Cameroon and the directorates of all participating hospitals to conduct this study. Also, informed consent will be sought from each patient or their legal next of kin and parents for minors, before enrolment into this study. The final study will be published in a peer-review journal and the findings presented to health authorities and healthcare providers.

Download Full-text