Pancreatic abnormalities detected by endoscopic ultrasound (EUS) in patients without clinical signs of pancreatic disease: any difference between standard and Rosemont classification scoring?
BACKGROUND
The prevalence of nine EUS features of chronic pancreatitis (CP) according to the standard Wiersema classification has been investigated in 489 patients undergoing EUS for an indication not related to pancreatico-biliary disease. We showed that 82 subjects (16.8%) had at least one ductular or parenchymal abnormality. Among them, 18 (3.7% of study population) had ≥3 Wiersema criteria suggestive of CP. Recently, a new classification (Rosemont) of EUS findings consistent, suggestive or indeterminate for CP has been proposed.


OBJECTIVE
To stratify healthy subjects into different subgroups on the basis of EUS features of CP according to the Wiersema and Rosemont classifications and to evaluate the agreement in the diagnosis of CP with the two scoring systems. Weighted kappa statistics was computed to evaluate the strength of agreement between the two scoring systems. Univariate and multivariate analysis between any EUS abnormality and habits were performed.


RESULTS
Eighty-two EUS videos were reviewed. Using the Wiersema classification, 18 subjects showed ≥3 EUS features suggestive of CP. The EUS diagnosis of CP in these 18 subjects was considered as consistent in only one patient, according to Rosemont classification. Weighted Kappa statistics was 0.34 showing that the strength of agreement was 'fair'. Alcohol use and smoking were identified as risk factors for having pancreatic abnormalities on EUS.


CONCLUSIONS
The prevalence of EUS features consistent or suggestive of CP in healthy subjects according to the Rosemont classification is lower than that assessed by Wiersema criteria. In that regard the Rosemont classification seems to be more accurate in excluding clinically relevant CP. Overall agreement between the two classifications is fair.
Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy. Electronic address: petrone.mariachiara@hsr.it.
Maria Chiara
MC
Petrone
Division of Gastroenterology, "Casa Sollievo della Sofferenza", Scientific Institute, San Giovanni Rotondo, Italy.
Fulvia
F
Terracciano
Division of Gastroenterology, "Casa Sollievo della Sofferenza", Scientific Institute, San Giovanni Rotondo, Italy.
Francesco
F
Perri
Digestive Endoscopy Unit, Istituto Clinico Humanitas, Milan, Italy.
Silvia
S
Carrara
Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy.
Giulia Martina
GM
Cavestro
Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy.
Alberto
A
Mariani
Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy.
Pier Alberto
PA
Testoni
Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy.
Paolo Giorgio
PG
Arcidiacono
D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D003661:Decision Support Techniques; D019160:Endosonography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010179:Pancreas / Q000000981:diagnostic imaging*; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014741:Video Recording
Chronic pancreatitis; Ductul changes; Endoscopic ultrasound; Parenchymal changes; Rosemont classification; Wiersema criteria