Comparison of Endoscopic Retrograde Cholangiopancreatography, Endoscopic Ultrasonography, and Fecal Elastase 1 in Chronic Pancreatitis and Clinical Correlation

Pancreatic cancer has the poorest prognosis among all cancers, and early diagnosis is essential for improving the prognosis. Along with radiologic modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), endoscopic modalities play an important role in the diagnosis of pancreatic cancer. This review evaluates the roles of two of those modalities, endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), in the diagnosis of pancreatic cancer. EUS can detect pancreatic cancer with higher sensitivity and has excellent sensitivity for the diagnosis of small pancreatic cancer that cannot be detected by other imaging modalities. EUS may be useful for the surveillance of pancreatic cancer in high-risk individuals. Contrast-enhanced EUS and EUS elastography are also useful for differentiating solid pancreatic tumors. In addition, EUS-guided fine needle aspiration shows excellent sensitivity and specificity, even for small pancreatic cancer, and is an essential examination method for the definitive pathological diagnosis and treatment decision strategy. On the other hand, ERCP is invasive and performed less frequently for the purpose of diagnosing pancreatic cancer. However, ERCP is essential in cases that require evaluation of pancreatic duct stricture that may be early pancreatic cancer or those that require differentiation from focal autoimmune pancreatitis.

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The Role of Endoscopic Retrograde Cholangiopancreatography in Acute and Chronic Pancreatitis

Journal of Clinical Gastroenterology ◽

10.1097/00004836-200205000-00017 ◽

2002 ◽

Vol 34 (5) ◽

pp. 560-568 ◽

Cited By ~ 12

Author(s):

Rama P. Venu ◽

Russell D. Brown ◽

Allan G. Halline

Keyword(s):

Chronic Pancreatitis ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Retrograde ◽

Acute And Chronic Pancreatitis

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Su1255 Fecal Elastase-1 in Patients With Suspected or Confirmed Chronic Pancreatitis and Its Relation to MRI and Secretin-MRCP Findings

Gastroenterology ◽

10.1016/s0016-5085(12)61747-8 ◽

2012 ◽

Vol 142 (5) ◽

pp. S-462 ◽

Cited By ~ 1

Author(s):

Yazan Abdalla ◽

Nimah Jamaluddin ◽

Sean M. Burns ◽

Samer Alkaade

Keyword(s):

Chronic Pancreatitis ◽

Fecal Elastase ◽

Elastase 1

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Diagnosis and Staging of Chronic Pancreatitis by Endoscopic Retrograde Cholangiopancreatography

Diagnostic Procedures in Pancreatic Disease ◽

10.1007/978-3-642-60580-2_24 ◽

1997 ◽

pp. 195-201

Author(s):

H. Bosseckert

Keyword(s):

Chronic Pancreatitis ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Retrograde

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The Diagnosis of Autoimmune Pancreatitis Using Endoscopic Ultrasonography

Diagnostics ◽

10.3390/diagnostics10121005 ◽

2020 ◽

Vol 10 (12) ◽

pp. 1005

Author(s):

Atsushi Kanno ◽

Eriko Ikeda ◽

Kozue Ando ◽

Hiroki Nagai ◽

Tetsuro Miwata ◽

...

Keyword(s):

Bile Duct ◽

Pancreatic Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Ultrasonography ◽

Autoimmune Pancreatitis ◽

Wall Thickening ◽

Endoscopic Retrograde ◽

Intraductal Ultrasonography ◽

Bile Duct Wall ◽

Duct Wall

Autoimmune pancreatitis (AIP) is characterized by enlargement of the pancreas and irregular narrowing of the main pancreatic duct. It is often associated with IgG4-related sclerosing cholangitis (IgG4-SC), in which the bile duct narrows. Although characteristic irregular narrowing of the pancreatic duct caused by endoscopic retrograde cholangiopancreatography is noted in AIP, it is difficult to differentiate between localized AIP and pancreatic carcinoma based on imaging of the pancreatic duct. While stenosis of the bile duct in IgG4-SC is characterized by longer-length stenosis than in cholangiocarcinoma, differentiation based on bile duct imaging alone is challenging. Endoscopic ultrasound (EUS) can characterize hypoechoic enlargement of the pancreas or bile duct wall thickening in AIP and IgG4-SC, and diagnosis using elastography and contrast-enhanced EUS are being evaluated. The utility of EUS-guided fine needle aspiration for the histological diagnosis of AIP has been reported and is expected to improve diagnostic performance for AIP. Findings in the bile duct wall from endoscopic retrograde cholangiopancreatography followed by intraductal ultrasonography are useful in differentiating IgG4-SC from cholangiocarcinoma. Diagnoses based on endoscopic ultrasonography play a central role in the diagnosis of AIP.

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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.

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