Endosonography of the pancreas: normal variation versus changes of early chronic pancreatitis

The normal pancreas may have a hypoechoic ventral segment that does not correlate with the presence of pancreas divisum. Elderly individuals and heavy alcohol users may have abnormalities of their pancreas detected by EUS that are entirely asymptomatic. In patients with early stages of chronic pancreatitis, EUS can reveal abnormalities when other imaging tests including ERCP are normal. Determining the accuracy of EUS in diagnosing chronic pancreatitis is made difficult by the absence of a readily available gold standard. Whether EUS-guided fine needle aspiration biopsy will assist in this determination requires further investigation.