Endoscopic ultrasonography and alcoholic patients: can one predict early pancreatic tissue abnormalities?

ABSTRACT

CONTEXT The diagnosis of chronic pancreatitis in early stages remains challenging and agreement between various methods is poor. Alcohol consumption is the most important cause of chronic pancreatitis. OBJECTIVE: The aim of this study was to evaluate the endosonographic evidence of pancreatic disease in patients with alcohol abuse. SETTING: Consecutive patients referred for endoscopic ultrasonography for various indications between May 2001 and December 2003. PATIENTS Two hundred twenty-eight patients were enrolled in the study. One hundred 89 patients were studied; 39 (17.1%) were excluded because the pancreas could not be completely assessed (n=23) or because a previous diagnosis of chronic pancreatitis and/or pancreatic neoplasm was suspected (n=16). DESIGN: Prospective study. The patients were divided into 2 groups alcoholics (n=17) and non-alcoholics (n=172). MAIN OUTCOME MEASURE: The assessment of pancreatic disease according to parenchymal and ductal changes as previously described by Catalano and Sahai (scores 1 and 2, respectively). RESULTS: The malefemale ratio was 7.5 and 0.9 in the alcoholic and the non-alcoholic groups, respectively (P=0.002). Mean ages were 53.0 and 47.8 years, respectively (P=0.156). Alcoholic patients had significantly (P<0.001) more endosonographic abnormalities than non-alcoholics for both scores. A ROC curve comparison between patients and controls showed that the best specificity and sensitivity combination was obtained for the number of EUS features greater than 1 and 2 for the scores 1 and 2, respectively. CONCLUSION: Alcoholic patients had significantly more endosonographic abnormalities reflecting possible early changes of chronic pancreatitis. By using reported scores, values up to 1 or 2 can be seen in patients with no risk for pancreatitis, suggesting that chronic pancreatitis should be considered only for scores equal to or greater than 2 or 3 for scores 1 and 2, respectively.