Endoscopy 2009; 41(10): 836-841
DOI: 10.1055/s-0029-1215061
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Prospective comparison of radial and linear endoscopic ultrasound for diagnosis of chronic pancreatitis

T.  Stevens1 , G.  Zuccaro1  Jr. , J.  A.  Dumot1 , J.  J.  Vargo1 , M.  A.  Parsi1 , R.  Lopez2 , H.  L.  Kirchner3 , E.  Purich4 , D.  L.  Conwell5
  • 1Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  • 2Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  • 3Center for Health Research, Geisinger Health System, Danville, Pennsylvania, USA
  • 4ChiRhoClin, Inc., Burtonsville, Maryland, USA
  • 5Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Further Information

Publication History

submitted 3 October 2008

accepted after revision 17 July 2009

Publication Date:
15 September 2009 (online)

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Commentaire de travail de T. Stevens et al., pp. 836Endoscopy 2009; 41(10): 921-921
DOI: 10.1055/s-0032-1306748

Background and study aims: Linear endoscopic ultrasonography (EUS) is currently favored by many endosonographers for the evaluation of pancreatic pathology. However, radial EUS was used in early studies validating EUS for chronic pancreatitis. Radial and linear EUS have never been compared for the diagnosis of chronic pancreatitis. The aim of this study was to compare radial and linear EUS for the diagnosis of chronic pancreatitis using the secretin-stimulated endoscopic pancreatic function test (ePFT) as the reference standard.

Patients and methods: One hundred consecutive patients evaluated for pain of possible pancreatic origin underwent combined radial EUS, linear EUS, and secretin ePFT during a single endoscopic session. EUS images were acquired on videotape and blindly scored by three reviewers. The main outcome measure was diagnostic accuracy.

Results: The accuracy of radial EUS and linear EUS (cutpoint ≥ 4 criteria) was 84 % and 74 %, respectively. The statistical test for noninferiority was significant (P < 0.001) suggesting that the accuracy of radial EUS is as good as or superior to linear EUS. The ratio of accuracy (πradial/πlinear) was 1.14 (95 % confidence interval [CI] 0.99 to 1.28). No statistically significant differences were found between radial and linear EUS in terms of sensitivity, specificity, or overall discriminative ability (area under receiver operating characteristic curve 0.84 vs. 0.76, P = 0.10). Interobserver variability was similar for radial (Fleiss’ κ = 0.61, 95 %CI 0.43 to 0.79) and linear EUS (κ = 0.50, 95 %CI 0.28 to 0.72).

Conclusions: The accuracy of radial EUS is as good as linear EUS for the diagnosis of chronic pancreatitis.

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T. StevensMD 

Department of Gastroenterology and Hepatology
Cleveland Clinic Foundation

9500 Euclid Ave
Desk A31
Cleveland
OH, 44195
USA

Fax: +1-216-444-6284

Email: stevent@ccf.org