Endoscopic Diagnostic of Chronic Pancreatitis

Chronic pancreatitis is defi ned as a continuous infl ammatory pancreatic disease, one characterized by irreversible morphological changes, often associates with pain and sometimes with the loss of endocrine and exocrine function. As a histological confi rmation of chronic pancreatitis is often unavailable, the diagnosis is traditionally based on imaging methods such as computerized tomography (CT) or endoscopic retrograde cholangiopancreatography (ERCP), and recently magnetic resonance cholangiopancreatography (MRCP) as a noninvasive alternative to ERCP. Developments in the classifi cation system of CP include the Marseille classifi cation of 1963 which offered histopathologic criteria for CP, the Cambridge classifi cation of 1984 which introduced imaging features of computed tomography (CT), transabdominal ultrasound (TUS) and endoscopic retrograde cholangiopancreatography (ERCP) for classifi cation of CP as well as Rosemont classifi cation system of 2007 which presented the endoscopic ultrasonography diagnosis of CP. Endoscopic ultrasonography (EUS) was fi rst introduced as a diagnostic method for evaluation of pancreatic disease in 1986. It has experienced signifi cant improvements since then and allowed for an alternative approach in diagnosing patients with pancreatic diseases. In patients with suspected pancreatic masses EUS-guided fi ne needle aspiration (EUS-FNA) is the best method for obtaining tissue diagnosis and differentiating CP from pancreatic carcinoma. The recent studies indicate that EUS is the method of choice when compared with other imaging methods such as ERCP because it frequently provides more accurate diagnostics. The aim of this review is to discuss the fi ndings in endoscopic diagnostics up to the present moment and to indicate advantages, limitations and possible complications along with the current recommendations in CP diagnostics