The Value Of Endoscopic Ultrasonography In The Diagnosis Of IgG4 Related Cholangiopancreaticoncreatopathy

Objective: To investigate the diagnostic value of endoscopic ultrasonography(EUS)and endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)in Ig G4-related biliary and pancreatic diseases.Methods: In this single-center retrospective study,25 patients with Ig G4-associated biliary and pancreatic diseases were included from January2017 to January 2019.And they all underwent endoscopic ultrasonography and guided fine-needle needle aspiration biops.EUS,MRI/MRCP and CT were used to evaluate the patients and its accuracy of the three methods were compared.All patients were followed up 7 days,1 month and 1 year after EUS-FNA procedure for complications,follow-up treatment and prognosis.Results:Of the 25 patients,76.0% were male and 24.0% were female.The serum levels of Ig G4,TB,DB and CA199 in all the patients were significantly lower than those before treatment(P < 0.05).The results of preoperative imaging EUS combined with FNA showed that 25 patients with Ig G4 related cholangiopancreatic diseases were detected,the detection rate was 100.0%;the results of CT showed that 23 patients were detected,the detection rate was 92.0%;the results of MRI/MRCP showed that 21 patients were detected,the detection rate was 84.0%;the sensitivity of EUS combined with FNA was 87.24%,the specificity was 73.00%,the positive predictive value was 88.62%,and the negative predictive value was73.00% The sensitivity of CT was 80.12%,the specificity was 67.00%,the positive predictive value was 86.49%,the negative predictive value was60.34%,and the accuracy was 83.33%;the sensitivity of MRI/MRCP was75.36%,the specificity was 70.00%,the positive predictive value was81.34%,the negative predictive value was 58.46%,and the accuracy was75.00%.25 patients were followed up after operation,1 patient had temporary abdominal pain 7 days after operation,and were relieved in the later stage without any active intervention;1 patient had increased blood amylase at the 7th day after operation,and the symptoms improved after symptomatic treatment;no complications such as fever and infection were found.The positive rate of puncture 4times was higher,while the safety of puncture 3 times was higher.Comapred with 19 G,the positive rate(33.33%)and safety(100.0%)of 22 G puncture needle was higher.Compared with micronegative pressure,the positive rate(33.33%)and safety(100.0%)of 10 ml negative pressure was higher.Among the three methods of pathological smear,pathological liquid-based cytology and histopathological examination,the positive rate of histopathological examination was higher(100.0%).Conclusion: Endoscopic ultrasonography has better accuracy,specificity,positive rate and safety in diagnosing and treating Ig G4-related biliary and pancreatic diseases,and could be widely used in clinical diagnosis and treatment of Ig G4-related biliary and pancreatic diseases.