Evaluation of pancreatic microvascularization in chronic pancreatitis by endoscopic ultrasound-guided detective flow imaging: a prospective, single-center, observational study.

Abstract

Introduction: early diagnosis of chronic pancreatitis (CP) is a clinical challenge. Endoscopic ultrasound-guided detective flow imaging (EUS-DFI) can evaluate pancreatic microvascularization, which may be altered in chronic inflammation. This study aimed to evaluate EUS-DFI findings in patients with CP.

Methods: prospective, single-center, observational study including patients undergoing EUS for known or clinically suspected CP. EUS criteria for CP were evaluated according to the Rosemont classification. EUS-DFI findings were analyzed and classified into three grades: grade 0 = absence of microvasculature; grade 1 = reticular pattern with mild microvascularization; and grade 2 = reticular pattern with marked microvascularization. The correlation between EUS-DFI and Rosemont classification was analyzed.

Results: two hundred and five patients (mean age 53 years, range 21-85, 107 males) were included. Thirty-four patients (16.6 %) had a normal pancreas, 55 (26.7 %) indeterminate findings of CP, 108 (52.7 %) suggestive changes of CP and eight (4.0 %) consistent with CP. EUS-DFI grade 0 was only seen in subjects with a normal pancreas, whereas an EUS-DFI grade 1 was usually associated with indeterminate and suggestive findings of CP (97.6 % of cases). Grade 2 was observed in some patients with suggestive CP and in all patients with definite findings of CP (p < 0.001). EUS-DFI was significantly different between groups according to Rosemont classification (p < 0.001).

Conclusion: EUS-DFI allows the assessment of pancreatic microvascularization in CP, which correlates with the severity of morphological changes of the disease.