Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(10): E1134-E1142
DOI: 10.1055/a-2409-5519
Original article

Contrast-enhanced endoscopic ultrasound for differential diagnosis of autoimmune pancreatitis: a meta-analysis

Shanshan Zhu
1   Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Ringgold ID: RIN191599)
,
Xinguang Cao
1   Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Ringgold ID: RIN191599)
,
Ghulam Nabi
2   ENdocrinology and Physiology, Institute of Nature Conservation PAS, Krakow, Poland (Ringgold ID: RIN175578)
,
Fangbin Zhang
1   Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Ringgold ID: RIN191599)
,
Ping Liu
1   Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Ringgold ID: RIN191599)
,
Jingwen Zhang
1   Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Ringgold ID: RIN191599)
,
Changqing Guo
1   Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Ringgold ID: RIN191599)
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims To assess the diagnostic value of contrast-enhanced endoscopic ultrasound (CE-EUS) for autoimmune pancreatitis and other solid pancreatic masses.

Patients and methods A systematic search of PubMed, Embase, and Web of Science was performed from inception to October 2022. We calculated individual and pooled sensitivities and specificities to determine the diagnostic ability of CE-EUS. In addition, we calculated I2 to test for heterogeneity and explored the source of heterogeneity by meta-regression analysis.

Results A total of 472 patients from seven eligible studies were included. The mean sensitivity and specificity of the Bivariate analysis were 0.84 (95% CI 0.71–0.92) and 0.95 (95% CI 0.84–0.99), respectively. The diagnostic advantage ratio was 107.91 (95% confidence interval [CI] 22.22–524.13), and the area under the summary receiver operating characteristics curve was 0.91 (95% CI 0.88–0.93). The overall heterogeneity of the studies is negligible (I2=0, 95% CI 0–100). However, notable heterogeneity was observed in the combined specificity (P <0.01, I2=74.82) and diagnostic odds ratio (P=0.05, I2=51.54). The heterogeneity in these aspects could be elucidated through sensitivity analysis.

Conclusions Our analysis showed that CE-EUS is useful in identifying autoimmune pancreatitis. However, further large sample size, multicenter, prospective studies are needed to demonstrate its utility.

Keywords

Pancreatobiliary (ERCP/PTCD) - Pancreatoscopy - Endoscopic ultrasonography

Supplementary Material



Publication History

Received: 10 September 2023

Accepted after revision: 25 April 2024

Article published online:
10 October 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Madhani K, Farrell JJ. Autoimmune pancreatitis: an update on diagnosis and management. Gastroenterol Clin North Am 2016; 45: 29-43
    CrossrefPubMedSearch in Google Scholar
  • 2 Facciorusso A, Barresi L, Cannizzaro R. et al. Diagnostic yield of endoscopic ultrasound-guided tissue acquisition in autoimmune pancreatitis: a systematic review and meta-analysis. Endosc Int Open 2021; 9: E66-E75
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Jang SI, Lee DK. Contrast-enhanced endoscopic ultrasonography: advance and current status. Ultrasonography (Seoul, Korea) 2014; 33: 161-169
    CrossrefPubMedSearch in Google Scholar
  • 4 Kanno A, Ikeda E, Ando K. et al. The diagnosis of autoimmune pancreatitis using endoscopic ultrasonography. Diagnostics (Basel, Switzerland) 2020; 10: 1005
    PubMedSearch in Google Scholar
  • 5 Kitano M, Sakamoto H, Matsui U. et al. A novel perfusion imaging technique of the pancreas: contrast-enhanced harmonic EUS (with video). Gastrointest Endosc 2008; 67: 141-150
    CrossrefPubMedSearch in Google Scholar
  • 6 Minami Y, Kudo M, Hatanaka K. et al. Radiofrequency ablation guided by contrast harmonic sonography using perfluorocarbon microbubbles (Sonazoid) for hepatic malignancies: an initial experience. Liver Int 2010; 30: 759-764
    CrossrefPubMedSearch in Google Scholar
  • 7 Cioni D, Lencioni R, Bartolozzi C. Therapeutic effect of transcatheter arterial chemoembolization on hepatocellular carcinoma: evaluation with contrast-enhanced harmonic power Doppler ultrasound. Eur Radiol 2000; 10: 1570-1575
    CrossrefPubMedSearch in Google Scholar
  • 8 Whiting PF, Rutjes AW, Westwood ME. et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155: 529-536
    CrossrefPubMedSearch in Google Scholar
  • 9 Van Houwelingen HC, Zwinderman KH, Stijnen T. A bivariate approach to meta-analysis. Stat Med 1993; 12: 2273-2284
    CrossrefPubMedSearch in Google Scholar
  • 10 Van Houwelingen HC, Arends LR, Stijnen T. Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 2002; 21: 589-624
    CrossrefPubMedSearch in Google Scholar
  • 11 Wacker C, Prkno A, Brunkhorst FM. et al. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis 2013; 13: 426-435
    CrossrefPubMedSearch in Google Scholar
  • 12 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539-1558
    CrossrefPubMedSearch in Google Scholar
  • 13 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
    CrossrefPubMedSearch in Google Scholar
  • 14 Hocke M, Ignee A, Dietrich CF. Contrast-enhanced endoscopic ultrasound in the diagnosis of autoimmune pancreatitis. Endoscopy 2011; 43: 163-165
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Kobayashi G, Fujita N, Noda Y. et al. Vascular image in autoimmune pancreatitis by contrast-enhanced color-Doppler endoscopic ultrasonography: Comparison with pancreatic cancer. Endosc Ultrasound 2014; 3: S13
    CrossrefPubMedSearch in Google Scholar
  • 16 Cho MK, Moon SH, Song TJ. et al. Contrast-enhanced endoscopic ultrasound for differentially diagnosing autoimmune pancreatitis and pancreatic cancer. Gut Liver 2018; 12: 591-596
    CrossrefPubMedSearch in Google Scholar
  • 17 Dong Y, D'onofrio M, Hocke M. et al. Autoimmune pancreatitis: Imaging features. Endosc Ultrasound 2018; 7: 196-203
    CrossrefPubMedSearch in Google Scholar
  • 18 Imazu H, Kanazawa K, Mori N. et al. Novel quantitative perfusion analysis with contrast-enhanced harmonic EUS for differentiation of autoimmune pancreatitis from pancreatic carcinoma. Scand J Gastroenterol 2012; 47: 853-860
    CrossrefPubMedSearch in Google Scholar
  • 19 Ishikawa T, Hirooka Y, Itoh A. et al. Usefulness of endoscopic ultrasonography (plain combined with contrast-enhanced) in the differentiation between autoimmune pancreatitis and pancreatic cancer. Gastrointest Endosc 2009; 69: AB246
    CrossrefPubMedSearch in Google Scholar
  • 20 Yamashita Y, Kato J, Ueda K. et al. Contrast-enhanced endoscopic ultrasonography for pancreatic tumors. Biomed Res Int 2015; 2015: 491782
    CrossrefPubMedSearch in Google Scholar
  • 21 Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 2005; 58: 882-893
    CrossrefPubMedSearch in Google Scholar
  • 22 Hardacre JM, Iacobuzio-Donahue CA, Sohn TA. et al. Results of pancreaticoduodenectomy for lymphoplasmacytic sclerosing pancreatitis. Ann Surg 2003; 237: 853-859
    CrossrefPubMedSearch in Google Scholar
  • 23 Kajiwara M, Gotohda N, Konishi M. et al. Incidence of the focal type of autoimmune pancreatitis in chronic pancreatitis suspected to be pancreatic carcinoma: experience of a single tertiary cancer center. Scand J Gastroenterol 2008; 43: 110-116
    CrossrefPubMedSearch in Google Scholar
  • 24 Abraham SC, Wilentz RE, Yeo CJ. et al. Pancreaticoduodenectomy (Whipple resections) in patients without malignancy: Are they all 'chronic pancreatitis'?. Am J Surg Pathol 2003; 27: 110-120
    CrossrefPubMedSearch in Google Scholar
  • 25 Sasson A R, Gulizia J M, Galva A. et al. Pancreaticoduodenectomy for suspected malignancy: have advancements in radiographic imaging improved results?. Am J Surgery 2006; 192: 888-893
    CrossrefPubMedSearch in Google Scholar
  • 26 Kennedy T, Preczewski L, Stocker SJ. et al. Incidence of benign inflammatory disease in patients undergoing Whipple procedure for clinically suspected carcinoma: a single-institution experience. Am J Surg 2006; 191: 437-441
    CrossrefPubMedSearch in Google Scholar
  • 27 Meng F-S, Zhang Z-H, Ji F. New endoscopic ultrasound techniques for digestive tract diseases: A comprehensive review. World J Gastroenterol 2015; 21: 4809-4816
    CrossrefPubMedSearch in Google Scholar
  • 28 Yoon SB, Moon SH, Song TJ. et al. Endoscopic ultrasound-guided fine needle aspiration versus biopsy for diagnosis of autoimmune pancreatitis: Systematic review and comparative meta-analysis. Digest Endosc 2021; 33: 1024-1033
    CrossrefPubMedSearch in Google Scholar
  • 29 Sontum PC. Physicochemical characteristics of sonazoid, a new contrast agent for ultrasound imaging. J Ultrasound Med Biol 2008; 34: 824-833
    CrossrefPubMedSearch in Google Scholar
  • 30 Masuzaki R, Shiina S, Tateishi R. et al. Utility of contrast-enhanced ultrasonography with Sonazoid in radiofrequency ablation for hepatocellular carcinoma. J Gastroenterol Hepatol 2011; 26: 759-764
    CrossrefPubMedSearch in Google Scholar
  • 31 He XK, Ding Y, Sun LM. Contrast-enhanced endoscopic ultrasound for differential diagnosis of pancreatic cancer: an updated meta-analysis. J Oncotarget 2017; 8: 66392-66401
    CrossrefPubMedSearch in Google Scholar