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Endoscopic ultrasound (EUS) is the long-established method of investigating known or suspected chronic pancreatitis (CP). It uses nine equally weighted parenchymal and ductal criteria, and a score of three to five criteria (the threshold varies among medical centers) is considered diagnostic. The sensitivity and specificity of EUS are strong, compared with that of the reference standard of endoscopic retrograde cholangiopancreatography (ERCP), and EUS correlates well with histological criteria. However, interobserver agreement is an area of weakness in diagnosing CP using the standard criteria: The kappa value for global diagnosis has been reported at 0.45, with poor-to-fair agreement on most of the individual features.
The Rosemont classifi…