American Pancreatic Association practice guidelines in chronic pancreatitis evidence-based report on diagnostic guidelines

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

*Corresponding author for this work

Research output: Contribution to journalArticle

178 Scopus citations

Abstract

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, endos-copy, 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.

Original languageEnglish (US)
Pages (from-to)1143-1162
Number of pages20
JournalPancreas
Volume43
Issue number8
DOIs
StatePublished - Nov 10 2014

Keywords

  • Chronic pancreatitis
  • Diagnosis
  • Evidence-based
  • Guidelines

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology

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  • Cite this

    Conwell, D. L., Lee, L. S., Yadav, D., Longnecker, D. S., Miller, F. H., Mortele, K. J., Levy, M. J., Kwon, R., Lieb, J. G., Stevens, T., Toskes, P. P., Gardner, T. B., Gelrud, A., Wu, B. U., Forsmark, C. E., & Vege, S. S. (2014). American Pancreatic Association practice guidelines in chronic pancreatitis evidence-based report on diagnostic guidelines. Pancreas, 43(8), 1143-1162. https://doi.org/10.1097/MPA.0000000000000237