ABSTRACT
El ultrasonido endoscopico (USE) constituye hoy en dia la prueba mas sensible para el diagnostico de pancreatitiscr¨®nica temprana. El hecho de diagnosticar precozmente esta patolog¨ªa es de fundamental relevancia a la hora de intervenir oportunamente sobre los posibles factores etiologicos, en el intento de limitar la respuesta infl amatoria, tratando de frenar y en algunos casos evitar la progresi¨®n a pancreatitis cronica avanzada y debilitante. La agudeza diagnostica del USE en pancreatitis cronica (PC) se ha visto favorecida con la utilización de criterios estrictos y con la creación de sistemas de puntuación, que evolucionaron hastael nacimiento de la clasificación de Rosemont, que de todas, es la más restrictiva, teniendo como objetivoestandarizar estos criterios y asignar diferentes valores a los hallazgos endosonográficos encontrados en la pancreatitis crónica en fase temprana o tardía. Siendo esta patología de difícil diagnóstico utilizando los métodos convencionales, en especial en las fases tempranas, el USE emerge como una excelente alternativa diagn¨®stica y terapéutica para el estudio de este grupo de pacientes.
diagnosis of this disease is of fundamental importance for timely intervention to limit the infl ammatory responsesto possible etiological factors and to slow or prevent progression to advanced and debilitating chronic pancreatitis. The diagnostic accuracy of EUS for chronic pancreatitis (CP) has been enhanced with the use of strict criteria and the creation of scoring systems which have evolved into the Rosemont classifi cation.This is the most restrictive classifi cation system of all: it aims at standardizing criteria and assigning values to endoscopic ultrasound fi ndings of chronic pancreatitis found in early or late phases.Since this disease is diffi cult to diagnose using conventional methods, especially in its early stages, EUS has emerged as an excellent diagnostic and therapeutic alternative for the study of this group of patients.
Subject(s)
Humans , Male , Female , Pancreatitis, Chronic , UltrasonicsABSTRACT
BACKGROUND/AIMS: The Rosemont classification system was designed to standardize the endosonographic assessment of chronic pancreatitis. To determine whether the Rosemont classification system can predict the response to pancreatic enzyme supplementation in patients undergoing endoscopic ultrasound (EUS) evaluation of suspected chronic pancreatitis. METHODS: Sixty-five patients were included with abdominal pain undergoing endosonography for suspected chronic pancreatitis were included. Patients completed a questionnaire for evaluation of their abdominal pain. Group 1 (n=13) had EUS findings consistent with or suggestive of chronic pancreatitis. Group 2 (n=45) had EUS findings that were normal or indeterminate in the Rosemont classification system. Patients were given pancreatic enzyme supplementation and then given a follow-up pain questionnaire for a mean of 37 days subsequent to EUS regarding the change in pain. RESULTS: Group 1 patients were more likely to have a response to pancreatic enzymes (62% vs 24%, p=0.012) and a decrease in their pain scale ratings (2.62 vs 0.29, p=0.01). Computed tomography findings of chronic pancreatitis and narcotic use did not predict the response to pancreatic enzyme supplementation. The individual Rosemont criteria of hyperechoic foci with shadowing (p=0.03), lobularity (p=0.02), and stranding (p=0.001) were associated with improvement of pain after treatment. CONCLUSIONS: The Rosemont classification system can identify patients who are more likely to have improvement in abdominal pain after treatment with pancreatic enzyme supplementation.