Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Diagnostic value of homogenous delayed enhancement in contrast-enhanced computed tomography images and endoscopic ultrasound-guided tissue acquisition for patients with focal autoimmune pancreatitis

  • Keisuke Yonamine (Department of Gastroenterology, Sendai City Medical Center) ;
  • Shinsuke Koshita (Department of Gastroenterology, Sendai City Medical Center) ;
  • Yoshihide Kanno (Department of Gastroenterology, Sendai City Medical Center) ;
  • Takahisa Ogawa (Department of Gastroenterology, Sendai City Medical Center) ;
  • Hiroaki Kusunose (Department of Gastroenterology, Sendai City Medical Center) ;
  • Toshitaka Sakai (Department of Gastroenterology, Sendai City Medical Center) ;
  • Kazuaki Miyamoto (Department of Gastroenterology, Sendai City Medical Center) ;
  • Fumisato Kozakai (Department of Gastroenterology, Sendai City Medical Center) ;
  • Hideyuki Anan (Department of Gastroenterology, Sendai City Medical Center) ;
  • Haruka Okano (Department of Gastroenterology, Sendai City Medical Center) ;
  • Masaya Oikawa (Department of Gastroenterological Surgery, Sendai City Medical Center) ;
  • Takashi Tsuchiya (Department of Gastroenterological Surgery, Sendai City Medical Center) ;
  • Takashi Sawai (Department of Pathology, Sendai City Medical Center) ;
  • Yutaka Noda (Department of Gastroenterology, Sendai City Medical Center) ;
  • Kei Ito (Department of Gastroenterology, Sendai City Medical Center)
  • Received : 2022.05.09
  • Accepted : 2022.07.27
  • Published : 2023.07.30
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Abstract

Background/Aims: We aimed to investigate (1) promising clinical findings for the recognition of focal type autoimmune pancreatitis (FAIP) and (2) the impact of endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-TA) on the diagnosis of FAIP. Methods: Twenty-three patients with FAIP were involved in this study, and 44 patients with resected pancreatic ductal adenocarcinoma (PDAC) were included in the control group. Results: (1) Multivariate analysis revealed that homogeneous delayed enhancement on contrast-enhanced computed tomography was a significant factor indicative of FAIP compared to PDAC (90% vs. 7%, p=0.015). (2) For 13 of 17 FAIP patients (76.5%) who underwent EUS-TA, EUS-TA aided the diagnostic confirmation of AIPs, and only one patient (5.9%) was found to have AIP after surgery. On the other hand, of the six patients who did not undergo EUS-TA, three (50.0%) underwent surgery for pancreatic lesions. Conclusions: Homogeneous delayed enhancement on contrast-enhanced computed tomography was the most useful clinical factor for discriminating FAIPs from PDACs. EUS-TA is mandatory for diagnostic confirmation of FAIP lesions and can contribute to a reduction in the rate of unnecessary surgery for patients with FAIP.

Keywords

Acknowledgement

We thank Fumiyoshi Fujishima, MD, PhD, Department of Pathology, Tohoku University School of Medicine and Miwa Uzuki, MD, PhD, Department of Nursing, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University for histological evaluations using cytological specimens and resected specimens from all subjects, and all staff in the Department of Pathology at Sendai City Medical Center for immunostaining all specimens in this case. In addition, we are grateful to Dr. Brian Breedlove, Associate Professor, Tohoku University School of Science, for the English proofreading.

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