Correlation between endoscopic ultrasound features according to Rosemont criteria and exocrine pancreatic function in chronic pancreatitis

Aims Endoscopic ultrasound (EUS) is the most sensitive method to diagnose chronic pancreatitis (CP) in its early stage, and Rosemont criteria (RC) are used to classify its findings. However, data on the correlation between EUS features and pancreatic exocrine insufficiency (PEI) are scarce. We aimed to investigate the correlation between EUS findings and PEI.

Methods This is a retrospective, monocentric cohort study concerning patients prospectively enrolled from 2016 to 2021, with definite or probable CP according to M-ANNHEIM criteria.All patients had a EUS performed and known data about exocrine function, both within 12 months from the diagnosis of CP. PEI was diagnosed for fecal elastase (FE) values ≤200 mcg/g or when overt steatorrhea was reverted by enzyme replacement therapy. To evaluate the association between EUS features and PEI, and the accuracy of RC in predicting PEI, logistic regression analyses, Rank correlation, ROC curve and area under the curve (AUROC) were performed.

Results 128 patients were examined (63.3% male, mean age 47 years). 69.5% had a diagnosis of PEI(69.7% based on reduced FE).At multivariate logistic regression among all the RC, only the presence of lithiasis in the main pancreatic duct (MPD) was associated with an increased risk of PEI (OR 2.92, 95% CI 1.29-6.61; p=0.01). Rank analysis showed a weak inverse correlation between Rosemont categories and FE (Spearman’s rho=-0.02; p=0.03). Accuracy of Rosemont was moderate(AUROC of 0.62, p=0.014, sensitivity 69.7%, specificity 53.8%).

Conclusions EUS structural findings seem of limited help in identifying patients at risk for PEI but for lithiasis of the MPD. Dynamic and functional tools, such as EUS elastography and pancreatic function tests(secretin), could improve the usefulness of EUS in evaluating exocrine function.

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Artikel online veröffentlicht:
14. April 2023