Endoscopic retrograde pancreatography criteria to diagnose autoimmune pancreatitis: An international multicentre study

Aravind Sugumar, Michael J. Levy, Terumi Kamisawa, George J M Webster, Myung Hwan Kim, Felicity T Enders, Zahir Amin, Todd H. Baron, Mike H. Chapman, Nicholas I. Church, Jonathan E. Clain, Naoto Egawa, Gavin J. Johnson, Kazuichi Okazaki, Randall K. Pearson, Stephen P. Pereira, Bret Thomas Petersen, Samantha Read, Raghuwansh P. Sah, Neomal S. SandanayakeNaoki Takahashi, Mark Topazian, Kazushige Uchida, Santhi Swaroop Vege, Suresh T Chari

Research output: Contribution to journalArticle

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Abstract

Background: Characteristic pancreatic duct changes on endoscopic retrograde pancreatography (ERP) have been described in autoimmune pancreatitis (AIP). The performance characteristics of ERP to diagnose AIP were determined. Methods: The study was done in two phases. In phase I, 21 physicians from four centres in Asia, Europe and the USA, unaware of the clinical data or diagnoses, reviewed 40 preselected ERPs of patients with AIP (n=20), chronic pancreatitis (n=10) and pancreatic cancer (n=10). Physicians noted the presence or absence of key pancreatographic features and ranked the diagnostic possibilities. For phase II, a teaching module was created based on features found most useful in the diagnosis of AIP by the four best performing physicians in phase I. After a washout period of 3 months, all physicians reviewed the teaching module and reanalysed the same set of ERPs, unaware of their performance in phase I. Results: In phase I the sensitivity, specificity and interobserver agreement of ERP alone to diagnose AIP were 44, 92 and 0.23, respectively. The four key features of AIP identified in phase I were (i) long (>1/3 the length of the pancreatic duct) stricture; (ii) lack of upstream dilatation from the stricture (<5 mm); (iii) multiple strictures; and (iv) side branches arising from a strictured segment. In phase II the sensitivity (71%) of ERP significantly improved (p<0.05) without a significant decline in specificity (83%) (p>0.05); the interobserver agreement was fair (0.40). Conclusions: The ability to diagnose AIP based on ERP features alone is limited but can be improved with knowledge of some key features.

Original languageEnglish (US)
Pages (from-to)666-670
Number of pages5
JournalGut
Volume60
Issue number5
DOIs
StatePublished - May 2011

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Pancreatitis
Multicenter Studies
Physicians
Pancreatic Ducts
Teaching
Pathologic Constriction
Chronic Pancreatitis
Pancreatic Neoplasms
Dilatation
Sensitivity and Specificity

ASJC Scopus subject areas

  • Gastroenterology

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Endoscopic retrograde pancreatography criteria to diagnose autoimmune pancreatitis : An international multicentre study. / Sugumar, Aravind; Levy, Michael J.; Kamisawa, Terumi; Webster, George J M; Kim, Myung Hwan; Enders, Felicity T; Amin, Zahir; Baron, Todd H.; Chapman, Mike H.; Church, Nicholas I.; Clain, Jonathan E.; Egawa, Naoto; Johnson, Gavin J.; Okazaki, Kazuichi; Pearson, Randall K.; Pereira, Stephen P.; Petersen, Bret Thomas; Read, Samantha; Sah, Raghuwansh P.; Sandanayake, Neomal S.; Takahashi, Naoki; Topazian, Mark; Uchida, Kazushige; Vege, Santhi Swaroop; Chari, Suresh T.

In: Gut, Vol. 60, No. 5, 05.2011, p. 666-670.

Research output: Contribution to journalArticle

Sugumar, A, Levy, MJ, Kamisawa, T, Webster, GJM, Kim, MH, Enders, FT, Amin, Z, Baron, TH, Chapman, MH, Church, NI, Clain, JE, Egawa, N, Johnson, GJ, Okazaki, K, Pearson, RK, Pereira, SP, Petersen, BT, Read, S, Sah, RP, Sandanayake, NS, Takahashi, N, Topazian, M, Uchida, K, Vege, SS & Chari, ST 2011, 'Endoscopic retrograde pancreatography criteria to diagnose autoimmune pancreatitis: An international multicentre study', Gut, vol. 60, no. 5, pp. 666-670. https://doi.org/10.1136/gut.2010.207951
Sugumar, Aravind ; Levy, Michael J. ; Kamisawa, Terumi ; Webster, George J M ; Kim, Myung Hwan ; Enders, Felicity T ; Amin, Zahir ; Baron, Todd H. ; Chapman, Mike H. ; Church, Nicholas I. ; Clain, Jonathan E. ; Egawa, Naoto ; Johnson, Gavin J. ; Okazaki, Kazuichi ; Pearson, Randall K. ; Pereira, Stephen P. ; Petersen, Bret Thomas ; Read, Samantha ; Sah, Raghuwansh P. ; Sandanayake, Neomal S. ; Takahashi, Naoki ; Topazian, Mark ; Uchida, Kazushige ; Vege, Santhi Swaroop ; Chari, Suresh T. / Endoscopic retrograde pancreatography criteria to diagnose autoimmune pancreatitis : An international multicentre study. In: Gut. 2011 ; Vol. 60, No. 5. pp. 666-670.
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abstract = "Background: Characteristic pancreatic duct changes on endoscopic retrograde pancreatography (ERP) have been described in autoimmune pancreatitis (AIP). The performance characteristics of ERP to diagnose AIP were determined. Methods: The study was done in two phases. In phase I, 21 physicians from four centres in Asia, Europe and the USA, unaware of the clinical data or diagnoses, reviewed 40 preselected ERPs of patients with AIP (n=20), chronic pancreatitis (n=10) and pancreatic cancer (n=10). Physicians noted the presence or absence of key pancreatographic features and ranked the diagnostic possibilities. For phase II, a teaching module was created based on features found most useful in the diagnosis of AIP by the four best performing physicians in phase I. After a washout period of 3 months, all physicians reviewed the teaching module and reanalysed the same set of ERPs, unaware of their performance in phase I. Results: In phase I the sensitivity, specificity and interobserver agreement of ERP alone to diagnose AIP were 44, 92 and 0.23, respectively. The four key features of AIP identified in phase I were (i) long (>1/3 the length of the pancreatic duct) stricture; (ii) lack of upstream dilatation from the stricture (<5 mm); (iii) multiple strictures; and (iv) side branches arising from a strictured segment. In phase II the sensitivity (71{\%}) of ERP significantly improved (p<0.05) without a significant decline in specificity (83{\%}) (p>0.05); the interobserver agreement was fair (0.40). Conclusions: The ability to diagnose AIP based on ERP features alone is limited but can be improved with knowledge of some key features.",
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T1 - Endoscopic retrograde pancreatography criteria to diagnose autoimmune pancreatitis

T2 - An international multicentre study

AU - Sugumar, Aravind

AU - Levy, Michael J.

AU - Kamisawa, Terumi

AU - Webster, George J M

AU - Kim, Myung Hwan

AU - Enders, Felicity T

AU - Amin, Zahir

AU - Baron, Todd H.

AU - Chapman, Mike H.

AU - Church, Nicholas I.

AU - Clain, Jonathan E.

AU - Egawa, Naoto

AU - Johnson, Gavin J.

AU - Okazaki, Kazuichi

AU - Pearson, Randall K.

AU - Pereira, Stephen P.

AU - Petersen, Bret Thomas

AU - Read, Samantha

AU - Sah, Raghuwansh P.

AU - Sandanayake, Neomal S.

AU - Takahashi, Naoki

AU - Topazian, Mark

AU - Uchida, Kazushige

AU - Vege, Santhi Swaroop

AU - Chari, Suresh T

PY - 2011/5

Y1 - 2011/5

N2 - Background: Characteristic pancreatic duct changes on endoscopic retrograde pancreatography (ERP) have been described in autoimmune pancreatitis (AIP). The performance characteristics of ERP to diagnose AIP were determined. Methods: The study was done in two phases. In phase I, 21 physicians from four centres in Asia, Europe and the USA, unaware of the clinical data or diagnoses, reviewed 40 preselected ERPs of patients with AIP (n=20), chronic pancreatitis (n=10) and pancreatic cancer (n=10). Physicians noted the presence or absence of key pancreatographic features and ranked the diagnostic possibilities. For phase II, a teaching module was created based on features found most useful in the diagnosis of AIP by the four best performing physicians in phase I. After a washout period of 3 months, all physicians reviewed the teaching module and reanalysed the same set of ERPs, unaware of their performance in phase I. Results: In phase I the sensitivity, specificity and interobserver agreement of ERP alone to diagnose AIP were 44, 92 and 0.23, respectively. The four key features of AIP identified in phase I were (i) long (>1/3 the length of the pancreatic duct) stricture; (ii) lack of upstream dilatation from the stricture (<5 mm); (iii) multiple strictures; and (iv) side branches arising from a strictured segment. In phase II the sensitivity (71%) of ERP significantly improved (p<0.05) without a significant decline in specificity (83%) (p>0.05); the interobserver agreement was fair (0.40). Conclusions: The ability to diagnose AIP based on ERP features alone is limited but can be improved with knowledge of some key features.

AB - Background: Characteristic pancreatic duct changes on endoscopic retrograde pancreatography (ERP) have been described in autoimmune pancreatitis (AIP). The performance characteristics of ERP to diagnose AIP were determined. Methods: The study was done in two phases. In phase I, 21 physicians from four centres in Asia, Europe and the USA, unaware of the clinical data or diagnoses, reviewed 40 preselected ERPs of patients with AIP (n=20), chronic pancreatitis (n=10) and pancreatic cancer (n=10). Physicians noted the presence or absence of key pancreatographic features and ranked the diagnostic possibilities. For phase II, a teaching module was created based on features found most useful in the diagnosis of AIP by the four best performing physicians in phase I. After a washout period of 3 months, all physicians reviewed the teaching module and reanalysed the same set of ERPs, unaware of their performance in phase I. Results: In phase I the sensitivity, specificity and interobserver agreement of ERP alone to diagnose AIP were 44, 92 and 0.23, respectively. The four key features of AIP identified in phase I were (i) long (>1/3 the length of the pancreatic duct) stricture; (ii) lack of upstream dilatation from the stricture (<5 mm); (iii) multiple strictures; and (iv) side branches arising from a strictured segment. In phase II the sensitivity (71%) of ERP significantly improved (p<0.05) without a significant decline in specificity (83%) (p>0.05); the interobserver agreement was fair (0.40). Conclusions: The ability to diagnose AIP based on ERP features alone is limited but can be improved with knowledge of some key features.

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