Which diagnostic tests are most useful in confirming a diagnosis of chronic pancreatitis in primary care?

Most useful diagnostic tests for confirming chronic pancreatitis in primary care:

• Initial imaging with abdominal ultrasound can identify complications and advanced disease but has limited usefulness for early diagnosis of chronic pancreatitis.
• Computed tomography (CT) scan is the preferred first-line imaging test due to its high sensitivity and specificity for diagnosing chronic pancreatitis and its ability to detect morphological pancreatic changes such as duct dilatation, strictures, atrophy, calcifications, and pseudocysts.
• If diagnosis remains uncertain or imaging is equivocal, specialist imaging such as magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and endoscopic ultrasound (EUS) may be required.
• Laboratory tests alone are insufficient for diagnosis in early stages as pancreatic function may be preserved and biochemical markers minimally abnormal.
• Referral to gastroenterology or a specialist pancreatic centre is recommended for confirmation of diagnosis and management planning.

Therefore, in primary care, the most useful diagnostic test to confirm chronic pancreatitis is a CT scan, with ultrasound playing a limited role and specialist imaging reserved for unclear cases or further assessment after referral.

References: NICE CKS, NICE NG104