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

Koh CJ 1 , Lakhtakia S 2 , Kida M 3 , Lesmana CRA 4 , Ang TL 5 , Vu CKF 6 Show all authors , Aye TT 7 , Park SH 8 , Almadi MA 9 , Chong CC 10 , Tang RSY 11 , Wu X 12 , Hilmi I 13 , Dhir V 14 , Pausawasdi N 15 , Basha J 2 , Jin ZD 16 , Yang AM 12 , Teoh AYB 10 , Seo DW 8 , Wang HP 17 , Ho KY 1

Affiliations 

  • 1 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 2 Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
  • 3 Department of Gastroenterology, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
  • 4 Digestive Disease & GI Oncology Center, Medistra Hospital, Jakarta, Indonesia
  • 5 Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
  • 6 Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore
  • 7 Department of Gastroenterology, Sanpya General Hospital, Thingan Gyun, Myanmar
  • 8 Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
  • 9 Department of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
  • 10 Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
  • 11 Institute of Digestive Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
  • 12 Department of Gastroenterology, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
  • 13 Division of Gastroenterology, University of Malaya, Kuala Lumpur, Malaysia
  • 14 Institute of Digestive and Liver Care, Global Hospital, Mumbai, India
  • 15 Mahidol University Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
  • 16 Department of Gastroenterology, The Second Military Medical University, Shanghai, China
  • 17 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Endoscopy, 2021 06;53(6):595-602.
PMID: 32650341 DOI: 10.1055/a-1217-3112

Abstract

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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