Abstract
In general, chronic pancreatitis has been diagnosed by morphological and functional methods, endoscopic retrograde pancreatography (ERP), and the caerulein-secretin (CS) test based on the Japanese Society of Gastroenterology clinical criteria for chronic pancreatitis. However, the degrees of morphological change and exocrine dysfunction are not related, especially in cases of mild to moderate chronic pancreatitis, and this discrepancy is thought to be explained by the fact that pancreatic function reflects parenchymal abnormalities. To estimate the relations of pancreatic function and morphology, we used 7.5 MHz linear and radial scanning endoscopic ultrasonography (EUS), by which we could detect parenchymal abnormalities more exactly than by other methods. The ability of diagnosis by EUS was compared to that of the CS test in 13 cases of normal controls and 43 cases of chronic pancreatitis diagnosed by ERP. The chronic pancreatitis was divided into two groups, diffuse (D) and local (L) . EUS findings, such as pancreatic margin, parenchymal echo level, and ductal system, were investigated. The results were: 1) Abnormality of the ductal system has slight relation to the CS test. 2) The ductal system and margin could be observed well by EUS, and change of the margin was not specific to chronic pancreatitis. 3) Among the EUS findings, parenchymal echo level was closely related to results of the CS test. As dysfunction indicated by the CS test progresses, the parenchymal echo level changes from a spotty high echo to a mixed pattern of spotty high echo with patchy low echo, and finally becomes a diffuse low echo pattern. 4) EUS could detect changes in both pancreatic morphology and function, and is useful in the diagnosis of chronic pancreatitis.
