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 male:female 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.