PROSPECTIVE ASSESSMENT OF THE ABILITY OF ENDOSCOPIC ULTRASOUND TO DIAGNOSE, EXCLUDE, OR ESTABLISH THE SEVERITY OF CHRONIC-PANCREATITIS FOUND BY ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

Background: Our aim was to verify endoscopic ultrasound (EUS) accuracy to diagnose, rule out, and establish the severity of chronic pancreat itis found by endoscopic retrograde cholangiopancreatography (ERCP). M ethods: Patients undergoing ERCP for unexplained abdominal pain and/or suspected chronic pancreatitis underwent EUS. EUS was performed by ex perienced operators who were aware of the history but blinded to ERCP results. Chronic pancreatitis was defined using the Cambridge classifi cation: 0 to 1 = ''normal,'' 2 to 4 = ''all chronic pancreatitis,'' 3 to 4 = ''moderate to severe chronic pancreatitis.'' The number of EUS criteria required to obtain sensitivity, specificity, positive and neg ative predictive values greater than or equal to 85% was determined. E US criteria for chronic pancreatitis are hyperechoic foci, hyperechoic strands, lobularity, hyperechoic duct, irregular duct, visible sidebr anches, ductal dilation, calcification, and cysts. Results: One hundre d twenty-six patients underwent EUS and.ERCP EUS was highly sensitive and specific (> 85%) depending on the number of criteria present. Chro nic pancreatitis is likely (PPV > 85%) when more than two criteria (fo r ''all chronic pancreatitis'')and more than six criteria (for ''moder ate to severe chronic pancreatitis'') are present. ''Moderate to sever e chronic pancreatitis'' is unlikely (NPV > 85%) when fewer than three criteria are present. Independent predictors of chronic pancreatitis were ''calcification'' (p = 0.000001), history of alcohol abuse (p = 0 .002), and the total number of EUS criteria (p = 0.008). Conclusions: EUS can accurately diagnose, rule out, and establish the severity of c hronic pancreatitis-found by ERCP.