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Endoscopic Ultrasonographic Evaluation of Therapeutic Intervention for Non-Alcoholic Early Chronic Pancreatitis

Koushiro Ohtsubo, Hisatsugu Mouri, Kaname Yamashita, Fumihito Toshima, Dai Inoue, Toshifumi Gabata, Hiroyuki Watanabe, Seiji Yano

Objectives The concept of early chronic pancreatitis was initially described in the 2009 Japanese diagnostic criteria for chronic pancreatitis. However, the clinical features of non-alcoholic early chronic pancreatitis have not been defined. The aim of this study is to elucidate the clinical features of non-alcoholic early chronic pancreatitis. Methods Thirteen patients, two men and 11 women were diagnosed with non-alcoholic early chronic pancreatitis by revised 2009 criteria. Their clinical features, including their radiologic and endoscopic ultrasonographic findings and clinical courses, were retrospectively reviewed. Results Ten (77%) patients presented with back pain in addition to upper abdominal pain. Pancreatic enzymes were elevated in the sera of seven (54%) patients. EUS findings included lobularity with honeycombing in one (8%), lobularity without honeycombing in seven (54%), hyperechoic foci without shadowing in 10 (77%), strands in 13 (100%), and hyperechoic main pancreatic duct margin in 11 (85%). Neither contrast-enhanced computed tomography nor magnetic resonance imaging/ magnetic resonance cholangiopancreatography showed definite abnormalities in the pancreatic parenchyma. However, magnetic resonance cholangiopancreatography showed evidence of pancreaticobiliary maljunction and pancreatic divisum in one patient each. Camostat mesilate and high titer pancreatic enzyme pancrelipase were effective for relief of pain in all the patients except for two. However, the nine patients followed up for several years showed no improvement in endoscopic ultrasonographic findings. Conclusions Endoscopic ultrasonography may be useful in diagnosing non-alcoholic early chronic pancreatitis, even though computed tomography and magnetic resonance imaging could not detect abnormalities. Medication was effective for relief of pain, but did not improve endoscopic ultrasonographic findings for non-alcoholic early chronic pancreatitis. Further investigations are necessary to identify methods to prevent non-alcoholic early chronic pancreatitis progression.