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Pancreas. 2014 Nov;43(8):1143-62. doi: 10.1097/MPA.0000000000000237.

American Pancreatic Association Practice Guidelines in Chronic Pancreatitis: evidence-based report on diagnostic guidelines.

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1
From the *Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH; †Division of Gastroenterology, Hepatology, and Endoscopy, Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA; ‡Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; §Department of Pathology, The Geisel School of Medicine at Dartmouth, Hanover, NH; ║Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL; ¶Department of Radiology, Beth Israel Deaconness Hospital, Harvard Medical School, Boston, MA; #Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN; **Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI; ††Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA; ‡‡Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH; §§Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, University of Florida, Gainesville, FL; ║║Department of Gastroenterology, University of Chicago, Chicago, IL; and ¶¶Division of Gastroenterology, Department of Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.

Abstract

The diagnosis of chronic pancreatitis remains challenging in early stages of the disease. This report defines the diagnostic criteria useful in the assessment of patients with suspected and established chronic pancreatitis. All current diagnostic procedures are reviewed, and evidence-based statements are provided about their utility and limitations. Diagnostic criteria for chronic pancreatitis are classified as definitive, probable, or insufficient evidence. A diagnostic (STEP-wise; survey, tomography, endoscopy, and pancreas function testing) algorithm is proposed that proceeds from a noninvasive to a more invasive approach. This algorithm maximizes specificity (low false-positive rate) in subjects with chronic abdominal pain and equivocal imaging changes. Furthermore, a nomenclature is suggested to further characterize patients with established chronic pancreatitis based on TIGAR-O (toxic, idiopathic, genetic, autoimmune, recurrent, and obstructive) etiology, gland morphology (Cambridge criteria), and physiologic state (exocrine, endocrine function) for uniformity across future multicenter research collaborations. This guideline will serve as a baseline manuscript that will be modified as new evidence becomes available and our knowledge of chronic pancreatitis improves.

PMID:
25333398
PMCID:
PMC5434978
DOI:
10.1097/MPA.0000000000000237
[Indexed for MEDLINE]
Free PMC Article

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