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THE USE OF ENDOSCOPIC ULTRASOUND IN DIAGNOSING CHRONIC PANCREATITIS IN PATIENTS WITH UNEXPLAINED PANCREATIC PAIN AND A HISTORY OF ACUTE PANCREATITIS
M Bélanger, J Romagnuolo, J Parent
Division of Gastroenterology, Montreal General Hospital, McGill University, Montréal, Québec
BACKGROUND: The prevalence of chronic pancreatitis (CP) in patients presenting with an attack of acute pancreatitis is unknown and variable across populations. Endoscopic ultrasound (EUS) is emerging as the most sensitive test to detect early CP.
AIM: To determine the prevalence of CP by EUS in patients with CP-type episodes of pain and a past history of acute pancreatitis.
METHODS: A retrospective analysis of patients who underwent EUS at the Montreal General Hospital from 97/08/01 to 00/08/01 and had a documented history of acute pancreatitis (amylase and/or lipase > 5 times the upper limit of normal and/or typical CT/MRI findings) and ongoing pancreatic-type pain, for ³ 3 months. Patients were excluded if prior ultrasound, CT, MRI, MRCP or ERCP diagnosed CP, if a pancreatic mass was found, or if steatorrhea was present. Presence of CP was defined as the presence of ³4 EUS criteria of CP. Other factors were sought from chart review (see table below). 95% CIs were calculated and the Fisher Exact test was used to compare proportions.
RESULTS: 19 patients were included, 15 of whom were female (79%). Mean age was 42.5±18.0 (SD) yrs. Six patients (32%; 95%CI: 11-53%) met the EUS criteria for CP. Of these, 5 were female (83%), and mean age was 40.7 yrs. The table below summarizes the prevalence of clinical factors in EUS-positive and negative patients (no statistically significant differences).
CONCLUSIONS: CP is prevalent in patients with pancreatic-type pain and a past history of acute pancreatitis. Since it cannot be predicted easily on clinical grounds, EUS is indicated as a diagnostic test in these patients.