title: Comparison of endoscopic retrograde cholangiopancreatography with papillary biopsy and endoscopic ultrasound-guided pancreatic biopsy in the diagnosis of autoimmune pancreatitis.
abstract: BACKGROUND
  International consensus diagnostic criteria (ICDC) have been proposed for the diagnostic criteria and algorithm of autoimmune pancreatitis (AIP). Although endoscopy is important in the diagnosis of AIP, practical patterns of its usage vary considerably worldwide. This study aimed to compare endoscopic retrograde cholangiopancreatography (ERCP) with papillary biopsy and endoscopic ultrasound (EUS)-guided pancreatic biopsy for diagnosing AIP using ICDC.
  
  
  METHODS
  We retrospectively reviewed and classified 165 Korean patients diagnosed by Korean criteria from June 2007 to October 2013. Among them, 61 patients underwent ERCP with duodenal papillary biopsy (group A) and 62 patients underwent EUS-guided pancreatic biopsy (group B). We analyzed the diagnostic criteria and levels of each criterion, and type of AIP before and after endoscopic procedures.
  
  
  RESULTS
  ERCP with papillary biopsy increased the diagnostic sensitivity from 65.6% (40/61) to 95.1% (58/61) (P < 0.01). EUS-guided pancreatic biopsy increased the diagnostic sensitivity from 50.0% (27/62) to 88.7% (55/62) (P < 0.01). The increases of diagnostic sensitivity in two endoscopic methods were not different statistically. In diagnosing definite AIP, EUS-guided pancreatic biopsy was more useful than ERCP with papilla biopsy (sensitivity; 79.0% vs. 65.6%, P < 0.01). EUS-guided pancreatic biopsy was helpful to classify type 1 and type 2 AIP in some patients. Procedure-related complication (mild pancreatitis) developed in one patient (1.6%) in group A and two patients (3.2%) in group B. ERCP with papillary biopsy was less expensive than EUS-guided pancreatic biopsy.
  
  
  CONCLUSIONS
  Both ERCP with papillary biopsy and EUS-guided pancreatic biopsy are safe and play important roles in diagnosing AIP according to the ICDC.
authors.affiliation: Department of Medicine, Incheon Sarang Hospital, Incheon, Republic of Korea.
authors.forename: Jae Gu
authors.initials: JG
authors.lastname: Jung
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: jongk.lee@samsung.com.
authors.forename: Jong Kyun
authors.initials: JK
authors.lastname: Lee
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kwang Hyuck
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kyu Taek
authors.initials: KT
authors.lastname: Lee
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Young Sik
authors.initials: YS
authors.lastname: Woo
authors.affiliation: Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
authors.forename: Woo Hyun
authors.initials: WH
authors.lastname: Paik
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: mhkim@amc.seoul.kr.
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000000981:diagnostic imaging / Q000473:pathology*; D001327:Autoimmune Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D001706:Biopsy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology*; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Autoimmune pancreatitis; ERCP; EUS-guided pancreatic biopsy; International consensus diagnostic criteria; Papillary biopsy; Type