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Pancreatology. 2018 May 21. pii: S1424-3903(18)30113-3. doi: 10.1016/j.pan.2018.05.008. [Epub ahead of print]

International consensus statements on early chronic Pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with The International Association of Pancreatology, American Pancreatic Association, Japan Pancreas Society, PancreasFest Working Group and European Pancreatic Club.

Author information

1
Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: Whitcomb@pitt.edu.
2
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
3
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
4
Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA.
5
Gastroenterology Unit, Department of Medicine and the Pancreas Institute, University of Verona, Verona, Italy.
6
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
7
Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary and MTA-SZTE Translational Gastroenterology Research Group, Szeged, Hungary.
8
Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan.
9
Department of Gastroenterology, Dokkyo Medical University, Mibu, Tochigi, Japan.
10
Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
11
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University, Tsu, Japan.
12
Department of Medicine A, University Medicine Greifswald, Germany.
13
Service de pancréatologie, Pôle des Maladies de l'Appareil Digestif, DHU UNITY, Centre de référence des maladies rares du pancréas (PAncreatic RAre DISeases), Centre de référence européen des tumeurs neuroendocrines digestives et pancréatiques, Hôpital Beaujon, Faculté Denis Diderot, APHP, Clichy, France.
14
Division of Gastroenterology & Hepatology, University of Alabama Birmingham, Birmingham, AL, USA.
15
Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
16
Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
17
Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GE, UK.
18
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.

Abstract

BACKGROUND:

Chronic pancreatitis (CP) is a progressive inflammatory disorder currently diagnosed by morphologic features. In contrast, an accurate diagnosis of Early CP is not possible using imaging criteria alone. If this were possible and early treatment instituted, the later, irreversible features and complications of CP could possibly be prevented.

METHOD:

An international working group supported by four major pancreas societies (IAP, APA, JPS, and EPC) and a PancreasFest working group sought to develop a consensus definition and diagnostic criteria for Early CP. Ten statements (S1-10) concerning Early CP were used to gauge consensus on the Early CP concept using anonymous voting with a 9 point Likert scale. Consensus required an alpha ≥0.80.

RESULTS:

No consensus statement could be developed for a definition of Early-CP or diagnostic criteria. There was consensus on 5 statements: (S2) The word "Early" in early chronic pancreatitis is used to describe disease state, not disease duration. (S4) Early CP defines a stage of CP with preserved pancreatic function and potentially reversible features. (S8) Genetic variants are important risk factors for Early CP and can add specificity to the likely etiology, but they are neither necessary nor sufficient to make a diagnosis. (S9) Environmental risk factors can provide evidence to support the diagnosis of Early CP, but are neither necessary nor sufficient to make a diagnosis. (S10) The differential diagnosis for Early CP includes other disorders with morphological and functional features that overlap with CP.

CONCLUSIONS:

Morphology based diagnosis of Early CP is not possible without additional information. New approaches to the accurate diagnosis of Early CP will require a mechanistic definition that considers risk factors, biomarkers, clinical context and new models of disease. Such a definition will require prospective validation.

KEYWORDS:

Acute pancreatitis; Alcohol; Chronic pancreatitis; Classification; Diagnosis; Endoscopic ultrasound; Fibrosis; Genetic; Model

PMID:
29793839
DOI:
10.1016/j.pan.2018.05.008

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