Utility of Endoscopic Retrograde Pancreatogram (ERP) to Diagnose Autoimmune Pancreatitis (AIP): An International, Double Blind, Randomized, Multicenter Study

Sugumar, Aravind; Levy, Michael J.; Kamisawa, Terumi; Kim, Myung–Hwan; Enders, Felicity; Amin, Zahir; Baron, Todd H.; Chapman, Mike; Church, Nicholas I.; Clain, Jonathan E.; Egawa, Naoto; Johnson, Gavin; Okazaki, Kazuichi; Pearson, Randall K.; Pereira, Stephen P.; Petersen, Bret T.; Read, Samantha; Sah, Raghuwansh P.; Sandanayake, Neomal S.; Takahashi, Naoki; Topazian, Mark D.; Uchida, Kazushige; Vege, Santhi Swaroop; Webster, George; Chari, Suresh T.

doi:10.1016/j.gie.2009.03.140

Cited by 7 publications

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“…The absence of dilatation of the main pancreatic duct (an important feature of AIP) can be inferred from a CT scan; however, ERP provides additional details not seen on CT scan or magnetic resonance cholangiopancreatography. ERP has poor sensitivity and interobserver agreement in centers that do not routinely perform ERP to diagnose AIP [25]. The additional benefit of ERP in the US strategy is not clear.…”

Section: Discussionmentioning

confidence: 99%

Distinguishing Pancreatic Cancer from Autoimmune Pancreatitis

Sugumar

Takahashi

Chari

2010

Curr Gastroenterol Rep

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Both autoimmune pancreatitis (AIP) and pancreatic cancer frequently present with obstructive jaundice. However, AIP is a rare disease and its diagnosis carries vastly different therapeutic and prognostic implications compared with that of pancreatic cancer. The clinical challenge is to distinguish AIP from pancreatic cancer, because the price of misdiagnosis can be heavy. Recently, two strategies for differentiating AIP from pancreatic cancer were published, one from Japan and the other from the United States. The Japanese strategy relies on cross-sectional imaging, endoscopic retrograde pancreatogram, and serum IgG4. The American strategy uses imaging (CT scan), serology (serum IgG4), and evidence of other organ involvement (on CT scan) as the first tier of tests. If the differentiation cannot be made by these methods, a core biopsy of the pancreas, steroid trial, or surgical resection is recommended. The two strategies reflect differences in clinical practice and local preferences in the use of certain diagnostic tests. However, both strategies require thorough familiarity with the diseases and the tests being used.

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Section: Discussionmentioning

confidence: 99%

Distinguishing Pancreatic Cancer from Autoimmune Pancreatitis

Sugumar

Takahashi

Chari

2010

Curr Gastroenterol Rep

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“…The Japanese strategy includes both CT and endoscopic retrograde pancreatogram (ERP) features, whereas the American strategy employs CT features alone to select patients for further cancer work‐up, mainly by means of attempts to obtain a tissue diagnosis. As ERP features have been reported to have limited sensitivity to diagnose AIP in Western centres, 42 in our practice, we use the American strategy (Figure 3). Further cancer work‐up by means of brush cytology at ERCP and endoscopic ultrasound‐guided fine‐needle aspiration is required in patients with indeterminate imaging, i.e.…”

Section: Methodsmentioning

confidence: 99%

Review article: autoimmune pancreatitis - management of an emerging disease

Kalaitzakis¹,

Webster²

2010

Alimentary Pharmacology &Amp; Therapeutics

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SUMMARY BackgroundAutoimmune pancreatitis is a steroid-responsive inflammatory pancreatic disease considered to be part of an immunoglobulin G4 (IgG4)-associated systemic disease. AimTo review the management of autoimmune pancreatitis. MethodsWe conducted a PubMed search using the following key words: autoimmune pancreatitis, IgG4-associated systemic disease, IgG4-associated cholangitis, diagnosis, natural history, treatment. ResultsAlthough there are reports of spontaneous resolution of autoimmune pancreatitis, steroids have been shown to be effective in inducing remission, reducing the frequency of relapse and that of long-term unfavourable events compared to historical controls. There are no randomised data on autoimmune pancreatitis treatment. Oral steroids are used for induction of remission. Reported response results are excellent with variable proportions of patients achieving remission in different studies. After a period of 2-4 weeks, steroids are tapered and usually withdrawn within several months, although long-term maintenance therapy for all autoimmune pancreatitis patients has also been proposed. Disease relapse occurs in more than 40% of patients and can be effectively treated with additional immunosuppression, including azathioprine. ConclusionsSteroids are effective in inducing remission and in treating relapse in patients with autoimmune pancreatitis. Randomised trials on autoimmune pancreatitis therapy are lacking. To date, questions concerning the timing, choice and duration of long-term immunosuppression remain unanswered.

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“…ERCP was shown to have poor reliability in preliminary results of a multicenter trial. 141 Classically, on cross-sectional imaging, diffuse pancreatic enlargement with delayed enhancement is noted, without pancreatic duct dilation, with or without a focal mass. The mass may demonstrate peripheral hypoattenuation and resemble a halo.…”

Section: Differentiating Inflammatory Pseudotumors From Neoplastic Mamentioning

confidence: 99%

EUS in Inflammatory Diseases of the Pancreas

Romagnuolo¹

2011

Endosonography

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Utility of Endoscopic Retrograde Pancreatogram (ERP) to Diagnose Autoimmune Pancreatitis (AIP): An International, Double Blind, Randomized, Multicenter Study

Cited by 7 publications

References 0 publications

Distinguishing Pancreatic Cancer from Autoimmune Pancreatitis

Distinguishing Pancreatic Cancer from Autoimmune Pancreatitis

Review article: autoimmune pancreatitis - management of an emerging disease

EUS in Inflammatory Diseases of the Pancreas

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