Editorial
Copyright ©2010 Baishideng Publishing Group Co.
World J Gastroenterol. Sep 14, 2010; 16(34): 4253-4263
Published online Sep 14, 2010. doi: 10.3748/wjg.v16.i34.4253
Table 1 Diagnostic value of endoscopic ultrasonography in chronic pancreatitis
AuthorNo. of ptsNo. of EUS criteriaThreshold for CP diagnosisComparisonSnSpPPVNPVAcc
Wiersema et al[4]6911> 3 = dgEUS vs ERCP10079
EUS vs ERCP + secretin test7033
EUS vs ERCP + history9066
Catalano et al[2]80111-2 mildEUS vs secretin test8478
3-5 moderateEUS vs ERCP86.195.4
> 5 severeEUS vs ERCP + secretin test84.297.6
Sahai et al[8]1269> 2 for any CPEUS vs ERCP> 85< 85
< 3 = fibrosis
> 6 = severe> 85
Conwell et al[14]5694-5 = equivocalEUS vs ePFT36949341
> 6 = definite2610010039
Stevens et al[13]8393-5 = dgEUS vs ERCP68798362
6-9 = severe
Stevens et al[10]1009> 4Radial EUS vs ePFT689584
Linear EUS vs ePFT449574
Stevens et al[12]509> 4EUS vs secretin ePFT7192
EUS vs CCK ePFT6385
Zimmermann et al[23]219> 4EUS vs histology (surgery)7873
Varadarajulu et al[24]219> 4EUS vs histology1 (surgery)9085.788.1
Chong et al[25]719> 3 = dgEUS vs histology1 (surgery)83.380
> 4 = severe fibrosis
Bhutani et al[22]119> 3EUS vs histology (autopsy)
Table 2 Correspondence between standard endoscopic ultrasonography criteria and pathologic features in chronic pancreatitis (adapted from Sahai AV 2002[21])
Standard EUS criteriaPathologic features
Parenchymal criteria
Hyperechoic fociSmall calcifications
Hyperechoic strandsFibrosis
LobularityEdema or fibrosis
CystsPseudocysts
CalcificationsCalcifications
Ductal criteria
MPD dilatationMPD dilatation
MPD irregularityMPD irregular
Hyperechoic MPD wallsDuctal fibrosis or edema
Visible side branchesDilated secondary branches
Table 3 Rosemont consensus definitions
RankFeaturesDefinitionLocation
Parenchymal features
1Major AHyperechoic foci with shadowingEchogenic structures ≥ 2 mm in length and width that shadowBody and tail only
2Major BLobularity with honeycombingWell-circumscribed, ≥ 5 mm structures with enhancing rims and relatively echo-poor centers, with ≥ 3 lobulesBody and tail only
MinorLobularity with honeycombingWell-circumscribed, ≥ 5 mm structures with enhancing rims and relatively echo-poor centers, with non-contiguous lobulesBody and tail only
3MinorHyperechoic foci without shadowingEchogenic structures ≥ 2 mm in length and width with no shadowingBody and tail only
4MinorCystsAnechoic, rounded/elliptical structures with or without septationsHead, body and tail only
5MinorStrandingHyperechoic lines ≥ 3 mm in length in at least two different directions with respect to the imaged planeBody and tail only
Ductal features
1Major AMPD calculiEchogenic structures within the MPD with acoustic shadowingHead, body and tail only
2MinorIrregularity of MPD contourUneven or irregular outline and ectatic courseBody and tail only
3MinorDilated side branches3 or more tubular anechoic structures each measuring ≥ 1 mm in width, budding from MPDBody and tail only
4MinorMPD dilation≥ 3.5 mm in body or > 1.5 mm in tailBody and tail only
5MinorHyperechoic duct marginEchogenic, distinct structure greater than 50%of the entire MPDBody and tail only
Table 4 Rosemont diagnostic stratification
StratumCriteria
Consistent with CP1 major feature A + ≥ 3 minor features
1 major feature A + major feature B
2 major feature
Suggestive of CP1 major feature A + < 3 minor features
1 major feature B + ≥ 3 minor features
≥ 5 minor features (any)
Indeterminate for CP3 or 4 minor features major feature B alone or with < 3 minor features
Normal ≤ 2 minor features1