Abstract
Background
Revised clinical criteria for autoimmune pancreatitis (AIP) have been proposed by the Research Committee of Intractable Disease of the Pancreas and the Japan Pancreas Society. These criteria require distinguishing AIP from neoplastic lesions. However, this can be difficult, and patients often undergo surgery on the basis of suspected pancreatic cancer (PC).
Methods
AIP was diagnosed in 25 patients at the Aichi Cancer Center Hospital (ACCH) according to the revised AIP criteria. In each patient, endoscopic ultrasonography (EUS) was used to describe the conventional pancreatic parenchymal and ductal features of chronic pancreatitis (Sahai criteria), and other abnormal features, namely, diffuse hypoechoic areas (DHAs), diffuse enlargement (DE), focal hypoechoic areas (FHAs), focal enlargement, bile duct wall thickening (BWT), lymphadenopathy, and peripancreatic hypoechoic margins (PHMs). We compared these features between 25 patients with AIP and 30 patients with pancreatic cancer resected at ACCH.
Results
Few conventional EUS features of chronic pancreatitis (CP) were seen in patients with AIP (mean, 2.0 features). Frequencies of DHA, DE, BWT, and PHM were significantly higher in AIP than in PC. DHAs, DE, and FHAs resolved after steroid treatment.
Conclusions
Novel EUS features of AIP are useful in distinguishing AIP from PC and for following the effects of steroid therapy.
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References
Sarles H, Sarles JC, Muratore R, Guien C. Chronic inflammatory sclerosis of the pancreas-an autoimmune pancreatic disease? Am J Dig Dis 1961;6:688–698.
Yoshida K, Toki F, Takeuchi T, Watanabe S, Shiratori K, Hayashi N. Chronic pancreatitis caused by autoimmune abnormality. Proposal of concept of autoimmune pancreatitis. Dig Dis Sci 1995;40:1561–1568.
Members of the Criteria Committee for Autoimmune Pancreatitis of the Japan Pancreas Society. Diagnostic criteria for autoimmune pancreatitis 2002 by the Japan Pancreas Society. Suizou 2002;17:585–587.
Okazaki K, Kawa S, Kamisawa T, Naruse S, Tanaka S, Nishimori I, et al. Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal. J Gastroenterol 2006;41:626–631.
Sahai AV, Zimmerman M, Aabakken L, Tarnasky PR, Cunningham JT, van Velse A, et al. Prospective assessment of the ability of endoscopic ultrasound to diagnose, exclude, or establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography. Gastrointest Endosc 1998;48:18–25.
Kim KP, Kim MH, Kim JC, Lee SS, Seo DW, Lee SK. Diagnostic criteria for autoimmune chronic pancreatitis revisited. World J Gastroenterol 2006;12:2487–2496.
Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, Zhang L, et al. Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol 2006;4:1010–1016;quiz 934.
Hisanaga K, Hisanaga A, Nagata K, Ichie Y. High speed rotating scanner for transgastric sonography. AJR Am J Roentgenol 1980;135:627–639.
Sivak MV, Kaufman A. Endoscopic ultrasonography in the differential diagnosis of pancreatic disease: a preliminary report. Scand J Gastroenterol 1986;123:130–134.
Raimondo M, Wallace MB. Diagnosis of early pancreatitis by endoscopic ultrasound. Are we there yet? J Pancreas 2004;5:1–7.
Wallace MB, Hawes RH. Endoscopic ultrasound in the evaluation and treatment of chronic pancreatitis. Pancreas 2001;23:26–35.
Farrel JJ, Garber J, Sahani D, Brugge WR. EUS findings in patients with autoimmune pancreatitis. Gastrointest Endosc 2004;60:927–936.
Hyodo N, Hyodo T. Ultrasonographic evaluation in patients with autoimmune-related pancreatitis. J Gastroenterol 2003;38:1155–1161.
Abraham SC, Wilentz RE, Yeo CJ, Sohn TA, Cameron JL, Boitnott JK, et al. Pancreaticoduodenectomy (Whipple resections) in patients without malignancy; are they all “chronic pancreatitis”? Am J Surg Pathol 2003;27:110–120.
Smith CD, Behrns KE, van Heerden JA, Sarr MG. Radical pancreatoduodenectomy for misdiagnosed pancreatic mass. Br J Surg 1994;81:585–589.
van Gulik TM, Reeders JW, Bosma A, Moojen TM, Smits NJ, Allema JH, et al. Incidence and clinical findings of benign, inflammatory disease in patients resected for presumed pancreatic head cancer. Gastrointest Endosc 1997;46:417–423.
Kamisawa T, Egawa N, Nakajima K, Tsuruta K, Okamoto A. Morphological changes after steroid therapy in autoimmune pancreatitis. Scand J Gastroenterol 2004;39:1154–1158.
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Hoki, N., Mizuno, N., Sawaki, A. et al. Diagnosis of autoimmune pancreatitis using endoscopic ultrasonography. J Gastroenterol 44, 154–159 (2009). https://doi.org/10.1007/s00535-008-2294-2
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DOI: https://doi.org/10.1007/s00535-008-2294-2