P3467 - EUS Elastography as an Adjunct for the Diagnosis of Chronic Pancreatitis: A Systematic Review and Meta-Analysis

Renato Beas, MD¹, Dalton A.. Norwood, MD², Eleazar Enrique. Montalvan-Sanchez, MD³, Elit Quingalahua, MD⁴, Ana Vilela, MD⁵, Janice Lester, ⁶, Jean M. Chalhoub, MD⁶, Jorge Machicado, MD, MPH^7
1Washington University School of Medicine in St. Louis / Barnes-Jewish Hospital, St. Louis, MO; ²UAB Minority Health & Health Equity Research Center, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL; ³Yale Digestive Diseases, New Haven, CT; ⁴Central Michigan University, Saginaw, MI; ⁵Eastern Virginia Medical School, Norfolk, VA; ⁶Staten Island University Hospital, Northwell Health, Staten Island, NY; ⁷University of Michigan, Ann Arbor, MI

Introduction: EUS elastography is a quantitative diagnostic method that measures tissue stiffness and can objectively estimate degree of pancreatic fibrosis. New generation EUS processors have the ability to perform elastography; however, the ability of EUS elastography ability to diagnose Chronic Pancreatitis (CP) is still uncertain. In this systematic review and meta-analysis, we aimed to assess the diagnostic performance of EUS elastography in the diagnosis of CP.

Methods: A comprehensive search of multiple databases including MEDLINE, EMBASE, and Cochrane Central was conducted by a medical librarian from inception to September 2023. We included all published studies of adult participants who underwent EUS elastography for the diagnosis of CP and utilized Rosemont criteria as the reference standard. Two reviewers independently screened and selected the studies. Statistical analyses were performed using Stata 18, utilizing the metandi and midas packages. A bivariate meta-analysis of sensitivity and specificity was performed, accounting for the correlation between these two measures.

Results: Among 519 articles identified, 66 studies were identified for full text review and 6 studies were eligible for inclusion (n= 1,004 patients). The fitted model for EUS elastography in diagnosing CP revealed a pooled sensitivity of 88% (95% CI: 77-94%) and pooled specificity of 87% (95% CI: 78-92%). This indicates that EUS elastography correctly identified 88% of the true positive cases of CP and 87% of the true negative cases. Additionally, moderate heterogeneity among the included studies was found, particularly for sensitivity, indicating variability in the diagnostic performance across different settings and populations. These results are depicted in Figure 1A, which shows the Forest Plot for the sensitivity and specificity for each study. A summary point on the HSROC (Hierarchical Summary Receiver Operating Characteristic) plot is shown in Figure 1B.

Discussion: Among patients without definite changes of CP, EUS combined with elastography seems to be a highly sensitive and specific imaging biomarker to objectively diagnose early minimal changes CP. Future studies are warranted to understand if elastography can predict progression to definite CP or development of pancreatic insufficiency.



Disclosures:


Renato Beas, MD¹, Dalton A.. Norwood, MD², Eleazar Enrique. Montalvan-Sanchez, MD³, Elit Quingalahua, MD⁴, Ana Vilela, MD⁵, Janice Lester, ⁶, Jean M. Chalhoub, MD⁶, Jorge Machicado, MD, MPH⁷. P3467 - EUS Elastography as an Adjunct for the Diagnosis of Chronic Pancreatitis: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.