Schwierige endosonografische Differenzialdiagnosen am Pankreas – chronische Pankreatitis

Zusammenfassung

Während des 11. Endosonografietages Berlin-Brandenburg (www.eus-bb.de) führten wir eine Befragung der Teilnehmer zu sieben einzelnen Videoaufzeichnungen einer Endosonografie des Pankreas durch. Die Teilnehmer wurden befragt, ob die Videosequenz die Diagnose einer chronischen Pankreatitis erlaubt und welche Kriterien diese oder eine alternative Diagnose nahelegen. Der κ-Koeffizient, der die Interobserver-Übereinstimmung der 76 Teilnehmer der Befragung beschreibt, war mit 0,28 gering. Ausgehend von den Fällen des interaktiven Video-Quiz, die in dieser Ausgabe von Endoskopie heute auch als Endosonografie-Quiz wiedergegeben sind [1], werden die endosonografischen Diagnosekriterien der chronischen Pankreatitis und die differenzialdiagnostischen Erwägungen diskutiert. Die bildgebende Diagnostik der chronischen Pankreatitis beruht auf Parenchym- und Gangkriterien. Daher ist der endoskopische Ultraschall (EUS) die Methode mit der höchsten diagnostischen Sensitivität, die allerdings durch eine im Vergleich zum bisherigen „Goldstandard“ der bildgebenden Diagnostik, der endoskopischen retrograden Cholangiopankreatografie (ERCP), geringere Spezifität erkauft wird. Die diagnostische Wertigkeit und Priorisierung der endosonografischen Kriterien der chronischen Pankreatitis sind Gegenstand einer lebhaften wissenschaftlichen Diskussion, die zur Publikation der Rosemont-Konsensuskriterien [2] führte.

Abstract

Seven videotapes were demonstrated to the attendees oft he 11^thSymposium on “Endoscopic Ultrasound in Berlin and Brandenburg” (www.eus-bb.de). Among them we performed a survey and asked if a single video tape would justify the diagnosis of chronic pancreatitis, additional we asked for the criteria the diagnosis was based on. The interobserver agreement of the 76 participants of this survey was low (κ = 0.28). Based on the cases of this video quiz (which are presented as endosonography quiz also in this issue of Endoskopie heute [1]) we discuss the endosonographic criteria and the differential diagnosis of chronic pancreatitis. The diagnosis of chronic pancreatitis is based on imaging of typical parenchymal and ductal features. Therefore endoscopic ultrasound (EUS) offers the highest diagnostic sensitivity among all imaging procedures. However, in comparison to ERP, which is traditionally regarded to be the “gold standard” of imaging, EUS has a lower specificity. The diagnostic value and the respective diagnostic value of the EUS criteria for the diagnosis of chronic pancreatitis are subject to scientific discussion. The recently established Rosemont consensus criteria [2] are the latest result of this discussion.

Schlüsselwörter

chronische Pankreatitis - Endosonografie - endoskopischer Ultraschall - Pankreas - Interobserver-Variabilität

Key words

chronic pancreatitis - endosonography - endoscopic ultrasound - pancreas - interobserver variability

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