Pancreatic morpho-functional imaging as a diagnostic approach for chronic asymptomatic pancreatic hyperenzymemia.
BACKGROUND
Magnetic resonance cholangio-pancreatography (MRCP) findings in people with chronic asymptomatic pancreatic hyperenzymemia (CAPH) have shifted the hypothesis that CAPH is always non-pathological. However, there have been no studies including both secretin-MRCP (S-MRCP) and endoscopic ultrasonography (EUS) to examine the pancreatic morphology in these subjects.


OBJECTIVE
To prospectively assess the diagnostic approach for CAPH using both pancreatic EUS and S-MRCP.


METHODS
In a case-control prospective study from January 2010 to December 2014, 68 consecutive subjects with CAPH were scheduled to undergo S-MRCP and EUS (CAPH group) in a tertiary care setting. In the same period, the EUS findings of this group were compared with 68 patients examined by EUS alone for submucosal lesions of the gastric fundus, matched for sex and age (control group).


RESULTS
EUS detected pancreatic alterations in 60.3% of the CAPH group and 13.2% of controls (p<0.001). S-MRCP showed pancreatic alterations in 51.5% in the CAPH group. With the combined procedures, pancreatic abnormalities were detected in 63.3%. The diagnoses established by the two techniques were concordant in 51 (75%) of the 68 CAPH subjects; in the remaining 17 (25%) the two methods gave additional information.


CONCLUSIONS
In people with CAPH S-MRCP and EUS are both recommended in order to detect pancreatic abnormalities before this biochemical alteration is confirmed as benign CAPH, or Gullo's syndrome.
Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy.
Milena
M
Di Leo
Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy.
Maria Chiara
MC
Petrone
Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy.
Raffaella Alessia
RA
Zuppardo
Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy.
Giulia Martina
GM
Cavestro
Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy.
Paolo Giorgio
PG
Arcidiacono
Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy.
Pier Alberto
PA
Testoni
Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy. Electronic address: mariani.alberto@hsr.it.
Alberto
A
Mariani
D000328:Adult; D000681:Amylases / Q000097:blood; D016022:Case-Control Studies; D049448:Cholangiopancreatography, Magnetic Resonance; D019160:Endosonography; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000201:enzymology*; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging* / Q000201:enzymology*; D011446:Prospective Studies; D012008:Recurrence; D012633:Secretin / Q000008:administration & dosage; D062606:Tertiary Care Centers
D012633:Secretin; D000681:Amylases
EUS; MRCP; Pancreas; Secretin stimulation