Chronic pancreatitis diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Overview

• The page name should be "Diagnostic study of choice for [disease name]", with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice."
• Goal:
  • To describe the most efficient/sensitive/specific test that is utilized for diagnosis of [disease name].
  • To describe the gold standard test for the diagnosis of [disease name].
  • To describe the diagnostic criteria, which may be based on clinical findings, physical exam signs, pathological findings, lab findings, findings on imaging, or even findings that exclude other diseases.
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Diagnostic Study of Choice

Gold standard/Study of choice:

• The diagnostic study of choice for chronic pancreatitis is magnetic resonance cholangiopancreatography (MRCP) because
  • It may help in the detailed assessment of the ductal changes.
  • It eliminates the need to perform endoscopic retrograde cholangiopancreatography (ERCP).

Diagnostic Criteria

• The diagnosis is difficult to establish as the laboratory results and the imaging may be normal.

Diagnostic findings suggestive of Chronic pancreatitis:

Diagnostic findings suggestive of Chronic pancreatitis include the triad of:

• Pancreatic calcifications
• Steatorrhea
• Diabetes mellitus

Diagnostic findings confirmatory for Chronic pancreatitis:

Diagnostic findings confirmatory for chronic pancreatitis may include

• Pancreatic calcifications seen on abdominal plain films or CT scan
• Beaded appearance of main pancreatic duct seen on pancreatogram
• Abnormal pancreatogram showing ectatic side branches from the main pancreatic duct
• Abnormal pancreatic function tests (Secretin test)

M-ANNHEIM diagnostic criteria of chronic pancreatitis

• The diagnosis usually requires a typical history of chronic pancreatitis (recurrent pancreatitis or abdominal pain).
• The diagnosis for the various forms of chronic pancreatitis can be established by the following features.

Form of chronic pancreatitis	Diagnostic criteria
Definite chronic pancreatitis	Established by one or more of the following additional criteria: Pancreatic calcifications Moderate or marked ductal lesions (according to the Cambridge classification) Marked and persistent exocrine insufficiency defined as pancreatic steatorrhea markedly reduced by enzyme supplementation Typical histology of an adequate histological specimen
Probable chronic pancreatitis	Established by one or more of the following additional criteria: Mild ductal alterations (according to the Cambridge classification) Recurrent or persistent pseudocysts Pathological test of pancreatic exocrine function (such as fecal elastase-1 test, secretin test, secretin–pancreozymin test) Endocrine insufficiency (i.e., abnormal glucose tolerance test)
Borderline chronic pancreatitis	Established as a first episode of acute pancreatitis with or without: A family history of pancreatic disease (i.e., other family members with acute pancreatitis or pancreatic cancer) The presence of M-ANNHEIM risk factors
Pancreatitis associated with alcohol consumption	Requires in addition to the above-mentioned criteria for definite, probable, or borderline chronic pancreatitis one of the following features: History of excessive alcohol intake (>80 g/day for some years in men, smaller amounts in women) or History of increased alcohol intake (20–80 g/day for some years) or History of moderate alcohol intake (<20 g/day for some years)

M-ANNHEIM pancreatic imaging criteria for US, CT, MRI/MRCP, and EUS based on imaging features as defined by the Cambridge classification

Cambridge grading	CT, US, MRI/MRCP	EUS
Normal	Quality study depicting whole gland without abnormal features
Equivocal	One abnormal feature	Four or fewer abnormal features (no differentiation between equivocal and mild)
Mild changes	Two or more abnormal features, but normal main pancreatic duct
Moderate changes	Two or more abnormal features, including minor main Five or more abnormal features pancreatic duct abnormalities (either enlargement between 2 and 4 mm or increased echogenicity of the duct wall)	Five or more abnormal features (no differentiation between moderate and marked)
Marked changes	As above with one or more of the required features of marked changes

References

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