Endosonography in Autoimmune Pancreatitis

AbstractAutoimmune pancreatitis is a rare disease which is hard to diagnose without a definitive histology. Therefore endosonographic experiences are quite limited and mostly down to case reports or series. Because of the lack of histologic proven cases, patients can be narrowed down by estimating the IgG4 level in the blood or by response to an immunosuppressive treatment. In addition, the authors are using endosonographic fine needle aspiration cytology with IgG4 staining in all cases without possible histology, usually obtained by percutaneous ultrasound-guided biopsy, to make the diagnosis more certain before starting a prednisolone course even; so this method is not recommended thus far.Autoimmune pancreatitis has been seen, mostly in younger people at the onset of the disease. Therefore the structural changes of the pancreas are not as pronounced as in later stages. Two endosonographic hints of autoimmune pancreatitis have been discovered in uncertain cases. First: a visible dense structure of the whole pancreas (blue coating in elastography), and second: a definite increase of neovascularization from the inflammatory type nicely displayed by contrast enhanced high mechanical and low mechanical index endosonography. This article is part of an expert video encyclopedia