"A decade of diagnostic efforts in pancreatic diseases (1985-1995)" The diagnostic access to the pancreas was revolutionized two decades ago by the advent of endoscopic retrograde pancreatography, ultrasound, and com puted tomography. The "hidden" organ was made visible by these diagnostic milestones. In a process of slow but continuous evolution, these imaging tech niques have been further refined and complemented by nuclear magnetic reso nance imaging, and together they provide the standards on which therapeutic decisions depend. Progress has also been made in the functional assessment of the pancreas in various conditions of disease such as acute pancreatitis, chronic pancreatitis, and cancer. New developments in molecular biology also promise more significant achievements in the near future. Ten years ago we gathered a panel of international specialists dedicated to the study and management of pancreatic diseases and invited them to share their experiences with the available diagnostic methods. We have now repeated this process in order to review the past decade of progress in diagnostic procedures in pancreatic disease and to update the current state of expertise and stimulate further developments. The concept of the meeting, held in Magdeburg in December 1995, was to individually analyze the different diagnostic procedures and their specific use in the different disease conditions. The rationale for the interpretation of diagnostic findings is derived from the understanding of basic physiological and pathophysiological events and the resultant morphological alterations.

Classification of Pancreatitis: Problems and Prospects

A. Acute Pancreatitis
Morphology of Acute Pancreatitis in Relation to Etiology and Pathogenesis
Clinical Presentation and Course of Acute Pancreatitis
I. Imaging Procedures
Ultrasound in the Diagnosis and Grading of Acute Pancreatitis
Computed Tomography in Acute Pancreatitis: Diagnosis, Staging, and Detection of Complications
Diagnosis of Infected Pancreatic Necrosis
Endoscopic Retrograde Cholangiopancreatography in Acute Pancreatitis: Indications and Limitations
II. Functional Methods
Appropriate Use of Serum Pancreatic Enzymes for the Diagnosis of Acute Pancreatitis
Identification of the Etiological Factor in Acute Pancreatitis
Exocrine Pancreatic Function During and Following Acute Pancreatitis
Endocrine Pancreatic Function During and Following Acute Pancreatitis
III. Prognostic Evaluation
Pathophysiological Determinants of Severity of Acute Pancreatitis
Clinical Value of Multifactorial Classification in the Prognostic Evaluation of Acute Pancreatitis
Biochemical Markers in the Early Prognostic Evaluation of Acute Pancreatitis
Prognostic Evaluation of Acute Pancreatitis: When- and How-Consequences for Clinical Management
Diagnostic and Prognostic Evaluation of Graft Pancreatitis
IV. Guidelines
Acute Pancreatitis: Diagnostic Guidelines for General Practitioners, Clinicians in Community Hospitals and in Specialized Centers
B. Chronic Pancreatitis
I. Chronic Pancreatitis: Clinical Features
Pathomorphological Feature of Chronic Pancreatitis
Pathophysiological Events in Chronic Pancreatitis: The Current Concept
Clinical Presentation and Course of Chronic Pancreatitis
Painless Versus Painful Chronic Pancreatitis
II. Imaging Procedures
Role of Ultrasonography inthe Diagnosis, Staging and Detection of Complications of Chronic Pancreatitis
Diagnosis and Staging of Chronic Pancreatitis by Computed Tomography
Diagnosis and Staging of Chronic Pancreatitis by Endoscopic Retrograde Cholangiopancreatography
Radiologic Imaging of Chronic Pancreatitis
Role of Pancreatic Duct Drainage for Evaluation of Pancreatic Pain
What Does the Surgeon Need in the Preoperative Evaluation of Chronic Pancreatitis?
III. Function Tests
Neuroendocrine Abnormalities of Upper Gut Function in Chronic Pancreatitis: Lessons for Physiology and Pathophysiology
Direct Pancreatic Function Tests in the Diagnosis and Staging of Chronic Pancreatitis
Oral Pancreatic Function Tests in the Diagnosis and Staging of Chronic Pancreatitis
Present and Future of Breath Tests in the Diagnosis of Pancreatic Insufficiency
Value of Serum Pancreatic Enzymes in the Diagnosis of Chronic Pancreatitis
New Fecal Tests in the Diagnosis of Exocrine Pancreatic Insufficiency
Extracellular Matrix in Pancreatic Diseases
Endocrine Pancreatic Function in the Diagnosis and Staging of Chronic Pancreatitis
IV. Chronic Pancreatitis: Guidelines
Diagnostic Standards for Chronic Pancreatitis
Standards in Surgical Treatment of Chronic Pancreatitis
C. Pancreatic Cancer
Langerhans Islets Are the Origin of Ductal-Type Adenocarcinoma
I. Imaging Procedures
Ultrasound and Endoscopic Ultrasound in the Diagnosis of Pancreatic Tumors
Computed Tomography and Magnetic Resonance Imaging in Pancreatic Cancer
Endoscopic Retrograde Cholangiopancreatography in the Diagnosis of Pancreatic Tumors
Role of Laparoscopy and Laparoscopic Ultrasound in Pancreatic Cancer
Intraportal Ultrasonography for Evaluation of Resectability in Pancreatic Cancer
II. Other Diagnostic Procedures
Serological Diagnosis of Pancreatic Cancer
Role of Cytology in the Diagnosis of Pancreatic Tumors
Scintigraphic Procedures in the Detection of Pancreatic Tumors: Role of Fluorodeoxyglucose Positron Emission Tomography
III. Molecular Biology
Clinical Applicability of Molecular Procedures in the Diagnosis of Pancreatic Cancer
IV. Guidelines
Pancreatic Cancer: Diagnostic Guidelines for General Practitioners and Clinicians in Community Hospitals and Specialized Centers.