Endoscopic ultrasound as a predictor and guide to successful endotherapy in chronic pancreatitis

摘要

Background and Objectives:Pancreatic calculi (PCs) are sequelae of chronic pancreatitis (CP) and may obstruct and produce ductal hypertension leading to pain, the cardinal feature of CP. Indications for endotherapy include stones <5 mm size, stones in the head of pancreas which are not impacted and absence of downstream strictures. The assessment before the procedure is done by magnetic resonance cholangiopancreatography (MRCP) or computed tomography (CT). However, problems are encountered during endoscopic retrograde cholangiopancreatography (ERCP) clearance which are not anticipated despite MRCP/CT. The problems are possible impacted stones, hard stones, indeterminate stricture, and change of finding during ERCP. Hence, controversy exists. Endoscopic ultrasound (EUS) can help by providing concordance or discordance with MRCP images and may help in further clarification. The aim of this study is to evaluate the role, feasibility, and management changes of EUS before ERCP in patients planned for endotherapy in CP. Another objective was to evaluate whether EUS features of pancreatic duct (PD) stones can serve as a predictor of successful removal during ERCP.