review of literature on clinical pancreatology - The Pancreapedia

endoscopic ultrasound accurately detected chronic pancreatitis, when compared withhistopathologic examination. The presence <strong>of</strong> 3 or more features <strong>of</strong> chronic pancreatitiscorrelates with the histologic diagnosis <strong>of</strong> chronic pancreatitis, however, up to 3 features arefrequently present in elderly patients dying <strong>of</strong> all causes [256].The endoscopic ultrasound (EUS) diagnosis <strong>of</strong> chronic pancreatitis relies on the presence <strong>of</strong>up to nine distinct pancreatic parenchymal and ductal abnormalities, without consideringother factors such as age, duration <strong>of</strong> disease or clinical symptoms. The goal <strong>of</strong> one studywas to examine the impact <strong>of</strong> patient symptoms on EUS findings in patients with chronicpancreatitis. All patients with previously suspected chronic pancreatitis who had symptomaticdisease referred to a medical center for pancreatic EUS were identified. Patients werestratified into two groups based on their clinical symptoms – pain only and steatorrhea ±pain. Groups were compared using two-tailed comparative testing. Fifty-three patients (group1) with pain only and 27 patients with steatorrhea ± pain (group 2) were identified. Patients ingroup 1 were younger and more likely female. Compared to group 1 (pain only), group 2(steatorrhea ± pain) had significantly more total (5.4 vs 3.3) and ductal abnormalities (2.6 vs0.8), although the number <strong>of</strong> parenchymal abnormalities between groups 1 and 2 was notdifferent. The presence <strong>of</strong> steatorrhea ± pain in patients with chronic pancreatitis undergoingpancreatic EUS examination is associated with more total and ductal abnormalities.Stratification based on underlying patient symptoms may be valuable as an adjunct toendosonographic findings in making or excluding the diagnosis <strong>of</strong> chronic pancreatitis [258].ERCP in childrenTo evaluate indications, findings, therapies, safety, and technical success <strong>of</strong> endoscopicretrograde cholangiopancreatography (ERCP) in children <strong>of</strong> a Children's Hospital inAmsterdam, the Netherlands a retrospective analysis by medical records was done. Successwas defined as obtaining accurate diagnostic information or succeeding in endoscopictherapy. Sixty-one children (age 3 days to 17 years, mean age 7 years) underwent a total <strong>of</strong>99 ERCPs. Of those patients, 51 percent (31/61) were younger than 1 year, 84 percent hadbiliary indications, and 16 percent had pancreatic indications for the performance <strong>of</strong> ERCP.The complication rate was 4 percent (4/99) and included substantial pancreatitis and mildirritated pancreas. No complications occurred in children younger than 1 year. Indications forERCP are different for children and adults. A laparotomy could be prevented in 12 percent <strong>of</strong>children with suspicion <strong>of</strong> biliary atresia [259].Breath testsAlthough the fecal elastase-1 test is a satisfactory pancreatic exocrine function test, breathtests that use stable isotopes have been developed recently as alternatives. We evaluatedthe usefulness <strong>of</strong> a 13 C-labeled mixed triglyceride breath test for assessing pancreaticexocrine function after pancreatic surgery. The breath test and the fecal elastase-1 test wereperformed on 7 healthy volunteers, 10 patients with chronic pancreatitis, and 95 patientsafter pancreatic surgery. The breath test was analyzed with isotope ratio mass spectrometryand the cumulative recovery <strong>of</strong> 13 CO 2 at 7 hours (% dose 13 C cum 7h) was calculated. Thefecal elastase-1 concentration was determined immunoenzymatically. Both the fecalelastase-1 concentration and the % dose 13 C cum 7h <strong>of</strong> chronic pancreatitis patients andpancreatic resection patients were less than those <strong>of</strong> healthy volunteers. In all subjects, %dose 13 C cum 7h correlated with the fecal elastase-1 concentration. Accuracy rates forclinical symptoms, including clinical steatorrhea, for the fecal test and the breath test were 62and 88 percent, respectively. It was concluded that the 13 C-labeled mixed triglyceride breathtest might be more useful than the fecal elastase-1 test for evaluating pancreatic exocrinefunction after pancreatic resection [260].