Background and study aims: Endoscopic ultrasonography (EUS) has become the method of choice for the diagnosis
of chronic pancreatitis in clinical practice. However, the criteria allowing the specific
diagnosis of the disease, mainly at non-advanced stages, are still under debate. Analysis
of tissue stiffness by quantitative EUS–elastography may provide additional relevant
information in this setting. The aim of this study was to evaluate the information
provided by quantitative EUS–elastography for the diagnosis of chronic pancreatitis.
Patients and methods: A prospective, consecutive, 1-year study was designed, and included patients who
underwent EUS for epigastric pain syndrome or known chronic pancreatitis. EUS–elastography
was performed using radial Pentax EUS and Hitachi EUB900. The strain ratio was measured
in the head, body, and tail of the pancreas, and the elastographic result was the
mean of these three values. EUS criteria of chronic pancreatitis and the Rosemont
classification were also evaluated. Data were analyzed by analysis of variance and
linear regression; diagnostic accuracy was based on the receiver operating characteristic
(ROC) curve analysis.
Results: A total of 191 patients (mean age 52 years, range 21 – 85; 103 male) were included;
92 (48.2 %) of them were finally diagnosed with chronic pancreatitis. A highly significant
direct linear correlation was found between the number of EUS criteria of chronic
pancreatitis and the strain ratio (r = 0.813; P < 0.0001). The area under the ROC curve was 0.949 (95 % confidence interval 0.916 – 0.982)
and the accuracy of EUS–elastography for diagnosing chronic pancreatitis was 91.1 %
(cut-off strain ratio of 2.25). The strain ratio varied significantly in different
Rosemont classification groups (P < 0.001).
Conclusions: EUS–elastography was an accurate tool for the diagnosis of chronic pancreatitis and
provided relevant and objective information to support EUS findings.
