Post written by John M. DeWitt, MD, from the Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, USA.
Chronic pancreatitis is easy to diagnose in the late stages due to characteristic imaging findings. Minimal change chronic pancreatitis (MCCP) is early disease with characteristic symptoms but little to no typical imaging features for chronic pancreatitis. EUS alone often over calls or is too sensitive to diagnose MCCP. Therefore, some physicians supplement an EUS examination with endoscopic pancreatic function tests (ePFTs) to diagnose or exclude exocrine pancreatic insufficiency (EPI) in suspected MCCP.
First, the impact of simultaneous ePFT results and EUS findings on the clinical diagnosis of chronic pancreatitis is not known. Second, the sensitivity and specificity of the diagnosis of EPI compared to the EUS diagnosis of chronic pancreatitis (5 or more EUS features) has not been described.
Findings from simultaneous EUS exam and ePFTs have a significant impact in the clinical assessment of chronic pancreatitis in patients with and without EUS evidence for chronic pancreatitis. Furthermore, the diagnosis of EPI had only a sensitivity and specificity of 23.4% and 78.6%, respectively, for the EUS diagnosis (5 or more features) of chronic pancreatitis. Further studies evaluating EUS, ePFTs, and histology from EUS-guided pancreatic biopsy should be considered.
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