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Endosc Ultrasound. 2018 Nov-Dec;7(6):395-403. doi: 10.4103/eus.eus_24_18.

Discriminating chronic pancreatitis from pancreatic cancer: Contrast-enhanced EUS and multidetector computed tomography in direct comparison.

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Department of Internal Medicine II, St. Elisabeth-Krankenhaus Leipzig, Leipzig; Medical Department, University of Muenster, Germany.
Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany.
Medical Department II, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany.
Department of Internal Medicine II, Hospital Meiningen, Meiningen, Germany.


Background and Objectives:

To compare the ability of multidetector computed tomography (MDCT) and contrast-enhanced EUS to discriminate chronic pancreatitis (CP) from pancreatic ductal adenocarcinoma (PDAC).

Subjects and Methods:

A total of 215 patients (age: 62 ± 15 years, sex: f/m 80/135) were included in this retrospective study. All patients were examined by conventional endoscopic B-mode and contrast-enhanced high mechanical index EUS (CEHMI-EUS). CELMI-EUS was performed in 159 patients and endoscopic sonoelastography (ESE) in 210 patients. MDCT was carried out in 131 patients as part of their clinical work-up. Radiological reports were retrospectively analyzed. Final diagnosis was achieved by biopsy and evaluation of cytological specimens collected was performed by EUS-FNA, surgery, or follow-up of 12 months or more in patients with benign findings. In a subgroup of 100 patients, all diagnostic five methods were performed, and head-to-head analysis was performed.


Sensitivity and specificity for MDCT were 89% and 70% and for CEHMI-EUS were 96% and 91%, respectively. Sensitivities and specificities for EUS were 92% and 63% for B-Mode EUS, 96% and 38% for ESE, and 82% and 76% for CELMI-EUS, respectively. In the head-to-head analysis, each modality had shown lower numbers for specificity than shown in the overall group analysis because of high drop-out rate. EUS-FNA for PDAC had a sensitivity of 96% and a specificity of 100%.


Contrast-enhanced EUS is a reliable tool in discriminating PDAC from CP.


Adenocarcinoma; elastography; guidelines; pancreas; pancreatitis

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Conflict of interest statement

D. Domagk has received honoraria for lectures from Olympus Europe and Falk Foundation. Consultancy fees were received from Hitachi Medical Systems and AbbVie.

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