Diagnostic performance of imaging modalities in chronic pancreatitis: a systematic review and meta-analysis

Issa, Y.; Kempeneers, M. A.; van Santvoort, H C; Bollen, T L; Bipat, S.; Boermeester, M. A.

doi:10.1007/s00330-016-4720-9

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Diagnostic performance of imaging modalities in chronic pancreatitis: a systematic review and meta-analysis

review-article

Author(s): Y. Issa ¹ , M. A. Kempeneers ¹ , H. C. van Santvoort ¹ , T. L. Bollen ² , S. Bipat ³ , M. A. Boermeester ¹ ^,

Publication date (Electronic): 27 January 2017

Journal: European Radiology

Publisher: Springer Berlin Heidelberg

Keywords: Chronic pancreatitis, Diagnostic imaging, Diagnostic accuracy, Meta-analysis

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Abstract

Objectives

Obtain summary estimates of sensitivity and specificity for imaging modalities for chronic pancreatitis (CP) assessment.

Methods

A systematic search was performed in Cochrane Library, MEDLINE, Embase and CINAHL databases for studies evaluating imaging modalities for the diagnosis of CP up to September 2016. A bivariate random-effects modeling was used to obtain summary estimates of sensitivity and specificity.

Results

We included 43 studies evaluating 3460 patients. Sensitivity of endoscopic retrograde cholangiopancreatography (ERCP) (82%; 95%CI: 76%-87%) was significant higher than that of abdominal ultrasonography (US) (67%; 95%CI: 53%-78%; P=0.018). The sensitivity estimates of endoscopic ultrasonography (EUS), magnetic resonance imaging (MRI), and computed tomography (CT) were 81% (95%CI: 70%-89%), 78% (95%CI: 69%-85%), and 75% (95%CI: 66%-83%), respectively, and did not differ significantly from each other. Estimates of specificity were comparable for EUS (90%; 95%CI: 82%-95%), ERCP (94%; 95%CI: 87%-98%), CT (91%; 95% CI: 81%-96%), MRI (96%; 95%CI: 90%-98%), and US (98%; 95%CI: 89%-100%).

Conclusions

EUS, ERCP, MRI and CT all have comparable high diagnostic accuracy in the initial diagnosis of CP. EUS and ERCP are outperformers and US has the lowest accuracy. The choice of imaging modality can therefore be made based on invasiveness, local availability, experience and costs.

Key Points

• EUS, ERCP, MRI and CT have high diagnostic sensitivity for chronic pancreatitis

• Diagnostic specificity is comparable for all imaging modalities

• EUS and ERCP are outperformers and US has the lowest accuracy

• The choice of imaging can be made based on clinical considerations

Related collections

Most cited references 61

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Incidence rates of post-ERCP complications: a systematic survey of prospective studies.

Angelo Andriulli, Silvano Loperfido, Grazia Napolitano … (2007)

To provide health-care providers, patients, and physicians with an exhaustive assessment of prospective studies on rates of complications and fatalities associated with endoscopic retrograde cholangiopancreatography (ERCP). We searched MEDLINE (1977-2006) for prospective surveys on adult patients undergoing ERCP. "Grey literature" was sought by looking at cited references to identify further relevant studies. Data on postprocedural pancreatitis, bleeding, infections, perforations, and miscellaneous events as well as their associated fatalities were extracted independently by two reviewers. Sensitivity analysis was performed to test for data consistency between multicenter versus single center studies, and old (1977-1996) versus recent (1997-2005) reports. In 21 selected surveys, involving 16,855 patients, ERCP-attributable complications totaled 1,154 (6.85%, CI 6.46-7.24%), with 55 fatalities (0.33%, CI 0.24-0.42%). Mild-to-moderate events occurred in 872 patients (5.17%, CI 4.83-5.51%), and severe events in 282 (1.67%, CI 1.47-1.87%). Pancreatitis occurred in 585 subjects (3.47%, CI 3.19-3.75%), infections in 242 (1.44%, CI 1.26-1.62%), bleeding in 226 (1.34%, CI 1.16-1.52%), and perforations in 101 (0.60%, CI 0.48-0.72%). Cardiovascular and/or analgesia-related complications amounted to 173 (1.33%, CI 1.13-1.53%), with 9 fatalities (0.07%, CI 0.02-0.12%). As compared with old reports, morbidity rates increased significantly in most recent studies: 6.27%versus 7.51% (P(c)= 0.029). ERCP remains the endoscopic procedure that carries a high risk for morbidity and mortality. Complications continue to occur at a relatively consistent rate. The majority of events are of mild-to-moderate severity.

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Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years.

Peter Cotton, Donald A. Garrow, Joseph Gallagher … (2009)

Complications of ERCP are an important concern. We sought to determine predictors of post-ERCP complications at our institution. GI TRAC is a comprehensive data set of patients who underwent ERCP at our institution from 1994 through 2006. Logistic regression models were used to evaluate 4 categories of complications: (1) overall complications, (2) pancreatitis, (3) bleeding, and (4) severe or fatal complications. Independent predictors of complications were determined with multivariable logistic regression. A total of 11,497 ERCP procedures were analyzed. There were 462 complications (4.0%), 42 of which were severe (0.36%) and 7 were fatal (0.06%). Specific complications of pancreatitis (2.6%) and bleeding (0.3%) were identified. Overall complications were statistically more likely among individuals with suspected sphincter of Oddi dysfunction (SOD) (odds ratio [OR] 1.91) and after a biliary sphincterotomy (OR 1.32). Subjects with a history of acute or chronic pancreatitis (OR 0.78) or who received a temporary small-caliber pancreatic stent (OR 0.69) had fewer complications. Post-ERCP pancreatitis was more likely to occur after a pancreatogram via the major papilla (OR 1.70) or minor papilla (OR 1.54) and among subjects with suspected SOD with stent placement (OR 1.45) or without stent placement (OR 1.84). Individuals undergoing biliary-stent exchange had less-frequent pancreatitis (OR 0.38). Biliary sphincterotomy was associated with bleeding (OR 4.71). Severe or fatal complications were associated with severe (OR 2.38) and incapacitating (OR 7.65) systemic disease, obesity (OR 5.18), known or suspected bile-duct stones (OR 4.08), pancreatic manometry (OR 3.57), and complex (grade 3) procedures (OR 2.86). This study characterizes a large series of ERCP procedures from a single institution and outlines the incidence and predictors of complications.

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The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease.

Alexander Schneider, J Matthias Löhr, Manfred V Singer (2007)

Several classification systems of chronic pancreatitis have been proposed to provide a basis for treatment and research. All of these previous classifications were designed at the height of pancreatic research of their respective times; thus, each represented the most current knowledge available to pancreatologists at the time. However, none of these classifications provide simultaneously a simple standardized system for the clinical classification of chronic pancreatitis according to etiology, clinical stage, and severity of the disease, nor are they consistently useful for directing clinical practice and comparing interinstitutional data. Thus, we aimed to develop a new classification system of chronic pancreatitis to provide a framework for studying the interaction of various risk factors on the course of the disease. We reviewed the literature on the clinical course of all different forms of chronic pancreatitis, and we reviewed all previous classification systems of the disease. This approach provided a basis for the development of a new and unifying classification of chronic pancreatitis. We established the M-ANNHEIM multiple risk factor classification system based on the current knowledge of acute and chronic pancreatitis. This classification allows patients to be categorized according to the etiology, clinical stage, and severity of their disease. The severity of pancreatic inflammation was assessed using a scoring system that takes into account the clinical symptoms and treatment options of chronic pancreatitis. Finally, four hypothetical patients were categorized according to the M-ANNHEIM classification system to provide examples of its applicability in clinical practice. The M-ANNHEIM multiple risk factor classification system is simple, objective, accurate, and relatively noninvasive, and it incorporates etiology, different stages of the disease, and various degrees of clinical severity. This new classification system will be helpful for investigating the impact and interaction of various risk factors on the course of the disease and will facilitate the comparison and combination of interinstitutional data.

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Author and article information

Contributors

M. A. Boermeester: +3120 566 2766 , m.a.boermeester@amc.uva.nl

Journal

Journal ID (nlm-ta): Eur Radiol

Journal ID (iso-abbrev): Eur Radiol

Title: European Radiology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0938-7994

ISSN (Electronic): 1432-1084

Publication date (Electronic): 27 January 2017

Publication date PMC-release: 27 January 2017

Publication date (Print): 2017

Volume: 27

Issue: 9

Pages: 3820-3844

Affiliations

[1 ]ISNI 0000000404654431, GRID grid.5650.6, Department of Surgery, , Academic Medical Centre, ; Meibergdreef 9, 1100DD Amsterdam, The Netherlands

[2 ]ISNI 0000 0004 0622 1269, GRID grid.415960.f, Department of Radiology, , St Antonius Ziekenhuis, ; Koekoekslaan 1, 3430EM Nieuwegein, The Netherlands

[3 ]ISNI 0000000404654431, GRID grid.5650.6, Department of Radiology, , Academic Medical Centre, ; Meibergdreef 9, 1100DD Amsterdam, The Netherlands

Article

Publisher ID: 4720

DOI: 10.1007/s00330-016-4720-9

PMC ID: 5544812

PubMed ID: 28130609

SO-VID: 43eb7804-3298-4ad2-af7f-1c75b6190f84

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 3 May 2016

Date revision received : 20 September 2016

Date accepted : 16 December 2016

Funding

Funded by: Academic Medical Center (AMC)

Custom metadata

ScienceOpen disciplines: Radiology & Imaging

Keywords: chronic pancreatitis,diagnostic imaging,diagnostic accuracy,meta-analysis

Data availability:

ScienceOpen disciplines: Radiology & Imaging

Keywords: chronic pancreatitis, diagnostic imaging, diagnostic accuracy, meta-analysis

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