Chronic pancreatitis is an irreversible disease of exocrine pancreas characterized by progressive destruction of pancreatic parenchyma and remodeling processes leading to the replacement of the exocrine parenchyma by extensive fibrosis. These changes result in malabsorption, diabetes mellitus and severe and chronic abdominal pain.
Moreover, it is possible the development of several complications which will determine the clinical course developing in some cases pancreatic pseudocyst (25-30%), bile duct strictures (40-50%), even pancreatic cancer (1-3%). The mainstay is detecting early pancreatic changes and treating its related complications.
Rosemont criteria for chronic pancreatitis
Major criteria A
1) Hyperechoic foci with shadowing (echogenic structure ≥2 mm length and width that shadow)
2) Lobularity with honeycombing (well circumscribed, ≥5 mm structures with enchaining rim and relatively echo pure center, contiguous ≥3 lobules)
3) Main pancreatic duct calculi (echogenic structure(s) within main pancreatic duct with shadowing)
Major criterion B
Honeycomb pattern of lobularity
Minor criteria
1) Lobularity without honeycombing (noncontiguous lobules)
2) Hyperechoic foci without shadowing
3) Cysts
4) Strands
5) Irregular pancreatic duct contour
6) Dilated side branches
7) Main pancreatic duct dilatation
8) Hyperechoic duct wall
Rosemont criteria denoting ‘’consistent with CP’’ is defined as (1) 1 major A criteria and ≥3 minor criteria, (2) 1 major A and major B criteria, or (3) 2 major A criteria.
EUS diagnosis of CP on the basis of Rosemont criteria
I. Consistent with chronic
A. 1 major A feature + ≥ 3 minor pancreatitis features
B. 1 major A feature + major B feature
C. 2 major A features
II. Suggestive of CP
A. 1 major A feature + < 3 minor features
B. 1 major B feature + ≥ 3 minor features
C. ≥ 5 minor features (any)
III. Indeterminate for CP
A. 3 to 4 minor features, no major features
B. Major B feature alone or with < 3 minor features
IV. Normal ≤ 2 minor features, no major feature
References:
- D’Souza SL, Anderson MA, Korsnes SJ, Elmunzer BJ, Piraka C, Menees S, Wamsteker EJ, Kwon RS, Scheiman JM, Elta GH. EUS Diagnostic Criteria for Chronic Pancreatitis: A Comparison of Conventional Versus Rosemont Criteria. Dig Dis Sci. 2015 Dec;60(12):3782-7. [Medline]
- Takasaki Y, Ishii S, Fujisawa T, Ushio M, Takahashi S, Yamagata W, Ito K, Suzuki A, Ochiai K, Tomishima K, Saito H, Isayama H. Endoscopic Ultrasonography Findings of Early and Suspected Early Chronic Pancreatitis. Diagnostics (Basel). 2020 Nov 27;10(12):1018. [Medline]
Created Aug 29, 2024.
