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American Pancreatic Association Practice Guidelines in Chronic Pancreatitis

2014; Lippincott Williams & Wilkins; Volume: 43; Issue: 8 Linguagem: Inglês

10.1097/mpa.0000000000000237

1536-4828

Darwin L. Conwell, Linda Lee, Dhiraj Yadav, Daniel S. Longnecker, Frank H. Miller, Koenraad J. Mortelé, Michael J. Levy, Richard S. Kwon, John Lieb, Tyler Stevens, Phillip P. Toskes, Timothy B. Gardner, Andrés Gelrud, Bechien U. Wu, Christopher E. Forsmark, Santhi Swaroop Vege,

Gastrointestinal disorders and treatments

The diagnosis of chronic pancreatitis remains challenging in early stages of the disease. This report defines the diagnostic criteria useful in the assessment of patients with suspected and established chronic pancreatitis. All current diagnostic procedures are reviewed, and evidence-based statements are provided about their utility and limitations. Diagnostic criteria for chronic pancreatitis are classified as definitive, probable, or insufficient evidence. A diagnostic (STEP-wise; survey, tomography, endoscopy, and pancreas function testing) algorithm is proposed that proceeds from a noninvasive to a more invasive approach. This algorithm maximizes specificity (low false-positive rate) in subjects with chronic abdominal pain and equivocal imaging changes. Furthermore, a nomenclature is suggested to further characterize patients with established chronic pancreatitis based on TIGAR-O (toxic, idiopathic, genetic, autoimmune, recurrent, and obstructive) etiology, gland morphology (Cambridge criteria), and physiologic state (exocrine, endocrine function) for uniformity across future multicenter research collaborations. This guideline will serve as a baseline manuscript that will be modified as new evidence becomes available and our knowledge of chronic pancreatitis improves.