Evaluation of pancreatic microvascularization in chronic pancreatitis by EUS-guided detective flow imaging (DFI): a prospective, single-centre, observational study.

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. Our study aimed to evaluate EUS-DFI findings in patients with CP.

Methods: Prospective, single-centre, 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 analysed 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 analysed.

Results: 205 patients (mean age 53 years, range 21-85, 107 males) were included. 34 patients (16.6%) had a normal pancreas, 55 (26.7%) indeterminate findings of CP, 108 (52.7%) suggestive changes of CP and 8 (4.0%) consistent with CP. An 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). A 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.