Endoscopic ultrasonographic study of autoimmune pancreatitis and the effect of steroid therapy
Tóm tắt
Recently, endoscopic ultrasonography (EUS) has been used for the diagnosis of chronic pancreatitis (CP); however, EUS diagnosis of autoimmune pancreatitis (AIP) varies among different researchers. We investigated EUS findings in AIP and retrospectively analyzed them before and after steroid therapy. The subjects were 32 patients with AIP and the EUS images of the pancreatic parenchyma were evaluated with reference to the Sahai criteria. Patients’ background factors detected by EUS were analyzed statistically. Peroral steroid was given to 23 of the 32 patients. EUS was also performed 2 weeks after the initiation of therapy in 14 of the 23 patients, and the changes in EUS were investigated. Microscope images were compared with EUS images in one patient who underwent surgical resection. EUS results included hyperechoic strands in 26 (81.3%) and lobularity in 17 (53.1%) patients. The patients’ background factors included the presence of splenic and/or portal vein occlusion or narrowing around the pancreas in patients who had neither hyperechoic strands nor lobularity (p = 0.002, p = 0.004). The numbers of EUS findings before versus after steroid therapy were 11 versus 5 for hyperechoic strands and 7 versus 2 for lobularity. Microscope images showed the coexistence of relatively well-maintained lobular structures of pancreatic acini and almost complete loss of such structures. EUS findings in AIP were similar to those in early-stage CP, and hyperechoic strands and lobularity seem to suggest a condition under which the histology of lobular structures of the pancreatic acini is relatively well-maintained. EUS results had improved within about 2 weeks of steroid therapy.
Tài liệu tham khảo
Sarles H, Sarles JC, Muratore R, Guien C. Chronic inflammatory sclerosis of the pancreas—an autonomous pancreatic disease? Am J Dig Dis. 1961;6:686–98.
Yoshida K, Toki F, Takeuchi T, Watanabe S, Shiratori K, Hayashi N. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci. 1995;40:1561–8.
Okazaki K, Kawa S, Kamisawa T, Naruse S, Tanaka S, Nishimori I, et al. Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal. J Gastroenterol. 2006;41:626–31.
Ryu JK. Overview of diagnostic criteria for autoimmune pancreatitis. Korean J Panc Biliary Tract. 2007;12:105–12.
Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, Zhang L, et al. Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol. 2006;4:1010–6.
Otsuki M, Chung JB, Okazaki K, Kin MH, Kamisawa T, Kawa S, et al. Asian diagnostic criteria for autoimmune pancreatitis: consensus of the Japan–Korea Symposium on Autoimmune Pancreatitis. J Gastroenterol. 2008;43:403–8.
Sivak MV, Kaufman A. Endoscopic ultrasonography in the differential diagnosis of pancreatic disease: a preliminary report. Scand J Gastroenterol. 1986;123:130–4.
Yasuda K, Mukai H, Fujimoto S, Nakajima M, Kawai K. The diagnosis of pancreatic cancer by endoscopic ultrasonography. Gastrointest Endosc. 1988;34:1–8.
Sahai AV, Zimmerman M, Aabakken L, Tarnasky PR, Cunningham JT, van Velse A, et al. Prospective assessment of the ability of endoscopic ultrasound to diagnose, exclude, or establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography. Gastrointest Endosc. 1998;48:18–25.
Wallance MB, Hawes RH. Endoscopic ultrasound in the evaluation and treatment of chronic pancreatitis. Pancreas. 2001;23:26–35.
Kahl S, Glasbrenner B, Leodolter A, Pross M, Schulz HU, Malfertheiner P. EUS in diagnosis of early chronic pancreatitis: a prospective follow-up study. Gastrointest Endosc. 2002;55:507–11.
Irisawa A, Katakura K, Ohira H, Sato A, Bhutani MS, Hernandez LV, et al. Usefulness of endoscopic ultrasound to diagnose the severity of chronic pancreatitis. J Gastroenterol. 2007;42(suppl):90–4.
Hyodo N, Hyodo T. Ultrasonographic evaluation in patients with autoimmune-related pancreatitis. J Gastroenterol. 2003;38:1155–61.
Farrell JJ, Garber J, Sahani D, Brugge WR. EUS findings in patients with autoimmune pancreatitis. Gastrointest Endosc. 2004;60:927–36.
Ito T, Nakano I, Koyanagi S, Miyahara T, Migita Y, Ogoshi K, et al. Autoimmune pancreatitis as a new clinical entity—three cases of autoimmune pancreatitis with effective steroid therapy. Dig Dis Sci. 1997;42:1458–68.
Kubota K, Kato S, Akiyama T, Fujita K, Yoneda M, Takahashi H, et al. A proposal for differentiation between early- and advanced-stage autoimmune pancreatitis by endoscopic ultrasonography. Dig Endosc. 2009;21:162–9.
Hoki N, Mizuno N, Sawaki A, Tajika M, Takayama R, Shimizu Y, et al. Diagnosis of autoimmune pancreatitis using endoscopic ultrasonography. J Gastroenterol. 2009;44:154–9.
Okabe Y, Tsuruta O, Suga H, Kinoshita H, Sata M, Toyonaga A. Endoscopic ultrasonography of autoimmune-related pancreatitis in five cases: the reticular pattern disappears after steroid therapy? Gastrointest Endosc. 2005;61:AB295.
Okabe Y, Tsuruta O, Suga H, Saitou F, Toyonaga A, Sata M. Endoscopic ultrasonography patterns of autoimmune pancreatitis. Gastrointest Endosc. 2006;63:AB263.
Levy MJ, Reddy RP, Wiersema MJ, Smyrk TC, Clain JE, Harewood GC, et al. EUS-guided trucut biopsy in establishing autoimmune pancreatitis as the cause of obstructive jaundice. Gastrointest Endosc. 2005;61:467–72.
Suda K, Nishimori I, Takase M, Oi I, Ogawa M. Autoimmune pancreatitis can be classified into early and advanced stages. Pancreas. 2006;33:345–50.
Shigekawa M, Yamao K, Sawaki A, Hara K, Takagi T, Bhatia V, et al. Is 18fluorodeoxyglucose positron emission tomography meaningful for estimating the efficacy of corticosteroid therapy in patients with autoimmune pancreatitis? J Hepatobiliary Pancreat Sci. 2010;17:269–74.