The Rosemont Criteria Can Predict the Pain Response to Pancreatic Enzyme Supplementation in Patients with Suspected Chronic Pancreatitis Undergoing Endoscopic Ultrasoun

BACKGROUND/AIMS: The Rosemont classification system was designed to standardize the endosonographic assessment of chronic pancreatitis. To determine whether the Rosemont classification system can predict the response to pancreatic enzyme supplementation in patients undergoing endoscopic ultrasound (EUS) evaluation of suspected chronic pancreatitis. METHODS: Sixty-five patients were included with abdominal pain undergoing endosonography for suspected chronic pancreatitis were included. Patients completed a questionnaire for evaluation of their abdominal pain. Group 1 (n=13) had EUS findings consistent with or suggestive of chronic pancreatitis. Group 2 (n=45) had EUS findings that were normal or indeterminate in the Rosemont classification system. Patients were given pancreatic enzyme supplementation and then given a follow-up pain questionnaire for a mean of 37 days subsequent to EUS regarding the change in pain. RESULTS: Group 1 patients were more likely to have a response to pancreatic enzymes (62% vs 24%, p=0.012) and a decrease in their pain scale ratings (2.62 vs 0.29, p=0.01). Computed tomography findings of chronic pancreatitis and narcotic use did not predict the response to pancreatic enzyme supplementation. The individual Rosemont criteria of hyperechoic foci with shadowing (p=0.03), lobularity (p=0.02), and stranding (p=0.001) were associated with improvement of pain after treatment. CONCLUSIONS: The Rosemont classification system can identify patients who are more likely to have improvement in abdominal pain after treatment with pancreatic enzyme supplementation.