Endoscopic sonography in the diagnosis of chronic pancreatitis in the early stage

The author summarizes in the submitted review diagnostic possibilities of early stages of chronic pancreatitis. He evaluates from that aspect possibilities of common imaging methods (ultrasonography, computer tomography, endoscopic retrograde cholangiopancreatography) and endoscopic ultrasonography (EUS). Evaluation of the secretory exocrine capacity by means of the secretin-cerulein test. Although the method is demanding from the aspect of routine diagnosis, it is a method with comparable sensitivity and perhaps even greater specificity than ERCP. Other tests of exocrine pancreatic secretion are not sufficiently sensitive to be used for this diagnosis. Among imaging methods ERCP which is still considered the gold standard, evaluates even subtle changes in the efferent system. Endoscopic ultrasonography visualizes rather discrete changes of the parenchymatous structure, areas of fibrosis and oedema, or changes in the echogenicity of the duct wall. At present in the diagnosis of early stages of chronic pancreatitis most probably a combination of the method evaluating the exocrine secretory capacity of the pancreas and sensitive imaging methods (ERCP) will be most satisfactory. Further studies will show whether and when EUS could replace ERCP.