Nutritional support is one of the additional treatment methods for the exocrine pancreatic insufficiency consequences in chronic pancreatitis. Nutritional insufficiency risk assessment in these patients, timely diagnosis, and its correction are based on the use of the most optimal methods and treatment schemes. The article presents an overview and analysis of the European Association for Clinical Nutrition and Metabolism (ESPEN) recently published guidelines on nutritional support in chronic pancreatitis
Chronic pancreatitis is one of the most challenging disorders from the perspective of its early diagnosis and effective treatment. Within the last decade, the diagnosis of early chronic pancreatitis has been firmly introduced into the practice of gastroenterology. The delineation of this form as an initial stage of chronic pancreatitis is based on the need in early and effective treatment that could cease the progression of the disease and reduce the possibility of its complications.
The diagnostic criteria of chronic pancreatitis have been described in details in the literature; however, specifics of the diagnosis in its early stage have been scarcely highlighted. Chronic pancreatitis is commonly diagnosed with a number of imaging techniques (they can show abnormalities in morphology of the pancreas), as well as laboratory tests (showing functional organ deficit). However, morphological and imaging techniques are insufficient for the diagnosis of the early chronic pancreatitis. A new integral strategy towards early diagnosis seems necessary, that would consider not only the morphology, but also potential etiology, risk factors of the disease and its complications in patients with suspected chronic pancreatitis.
The review of the literature presents the definition of the early pancreatitis and discusses the potential of imaging techniques and functional tests in its diagnosis. An adequate strategy for the diagnosis of the early pancreatitis is formulated, based on an individual patient characteristic with suspected early chronic pancreatitis, namely, risk factors, clinical manifestations, imaging results and serological biomarkers.
EP-210Introduction: Our aim is to explore the diagnostic value of the new approach of pancreatic cancer (PC) diagnosis in patients with chronic pancreatitis (CP) by mathematical postprocessing of multidetector 128-row computed tomography (MDCT) results. Methods: We analyzed results of contrast-enhanced MDCT from 122 patients with CP: 71 (58.2%) males and 51 (41.8%) females, mean age 53.7 ± 13.03 (30-83), who underwent MDCT from January 2018 to October 2019. All cases were pathologically proved by core-biopsy or surgery. We calculated median of enhancement gradient in Hounsfield units (HU) between region of interest and intact parenchyma (Mgrad) based on multiphase MDCT results. Correlation assessed by Pearson's correlation coefficient (r). The ROC curves were performed to evaluate diagnosis potential of Mgrad. Results: There were 46 (37.7%) patients with PC and 76 (62.3%) patients with only CP. Mean Mgrad value was higher in PC-group -26.5 ± 8.6 HU than in CP-group -13.9 ± 5.1 HU (р = 0.0001); Mgrad cut-off value for PC was 20 HU (p = 0.001). There was positive correlation of Mgrad in patients with PC (r = 0.68, p = 0.0001) and negative correlation in patients with CP (r = -0.68, p = 0.0001). Sensitivity, specificity, accuracy, positive and negative predictive value of PC diagnosis were 89.1%, 96.1%, 93.4%, 93.2%, 93.6% for Mgrad and 69.5%, 92.1%, 83.6%, 84.2%, 83.3% for MDCT, respectively; area under ROC for Mgrad was higher (0.927) than for MDCT (0.863). Conclusions: Mgrad assessment based on MDCT results is more effective than only MDCT for PC diagnosis in patients with CP. Mgrad value positively correlates with PC existence, therefore it could be useful for PC diagnosis.
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