REED - Revista Española de Enfermedades Digestivas

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Año 2025 / Volumen 117 / Número 7
Original

Evaluation of pancreatic microvascularization in chronic pancreatitis by endoscopic ultrasound-guided detective flow imaging: a prospective, single-center, observational study

382-388

DOI: 10.17235/reed.2025.11054/2025

Yessica Domínguez-Novoa, Enrique Domínguez-Muñoz, Xurxo Martínez-Seara, José Lariño-Noia, Julio Iglesias-García,

Resumen

Introduction: early diagnosis of chronic pancreatitis (CP) is a clinical challenge. Endoscopic ultrasound-guided detective flow imaging (EUS-DFI) can evaluate pancreatic microvascularization, which may be altered in chronic inflammation. This study aimed to evaluate EUS-DFI findings in patients with CP. Methods: prospective, single-center, observational study including patients undergoing EUS for known or clinically suspected CP. EUS criteria for CP were evaluated according to the Rosemont classification. EUS-DFI findings were analyzed and classified into three grades: grade 0 = absence of microvasculature; grade 1 = reticular pattern with mild microvascularization; and grade 2 = reticular pattern with marked microvascularization. The correlation between EUS-DFI and Rosemont classification was analyzed. Results: two hundred and five patients (mean age 53 years, range 21-85, 107 males) were included. Thirty-four patients (16.6 %) had a normal pancreas, 55 (26.7 %) indeterminate findings of CP, 108 (52.7 %) suggestive changes of CP and eight (4.0 %) consistent with CP. EUS-DFI grade 0 was only seen in subjects with a normal pancreas, whereas an EUS-DFI grade 1 was usually associated with indeterminate and suggestive findings of CP (97.6 % of cases). Grade 2 was observed in some patients with suggestive CP and in all patients with definite findings of CP (p < 0.001). EUS-DFI was significantly different between groups according to Rosemont classification (p < 0.001). Conclusion: EUS-DFI allows the assessment of pancreatic microvascularization in CP, which correlates with the severity of morphological changes of the disease.

Resumen coloquial

Early diagnosis of chronic pancreatitis is a clinical challenge. This study aimed to evaluate a new imaging method (Endoscopic ultrasound-guided detective flow imaging (EUS-DFI), that allows the detection of small vessels (microvascularization) in the diagnosis of this disease. According to the stage of chronic pancreatitis (classified according to Rosemont classification), EUS-DFI findings were analyzed and classified into three grades (0-2), according to the presence or absence of vascularization. EUS-DFI grade 0 was only seen in subjects with a normal pancreas, whereas an EUS-DFI grade 1 was usually associated with indeterminate and suggestive findings of chronic pancreatitis, and grade 2 was observed in some patients with suggestive and in all patients with consistent findings of chronic pancreatitis. EUS-DFI allows the assessment of pancreatic microvascularization, which correlates with the severity of the disease.

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