evaluation of endosonography as a new diagnostic tool for feline pancreatitis

Journal of Feline Medicine and Surgery (2009) 11, 492e498doi:10.1016/j.jfms.2008.11.007

Evaluation of endosonography as a new diagnostictool for feline pancreatitis

Ariane Schweighauser Dr Med Vet, DACVIM1*, Frederic Gaschen Dr Med Vet, Dr habil, DACVIM/

DECVIM-CA2, Jorg Steiner Dr Med Vet, PhD, DACVIM/DECVIM-CA

3, Karin Allenspach Dr Med Vet, PhD,

DECVIM-CA4, Thierry Francey Dr Med Vet, DACVIM

1, Lorrie Gaschen Dr Med Vet, PhD, Dr habil, DECVDI2

1Division of Small Animal InternalMedicine, Vetsuisse Faculty,University of Berne, Berne,Switzerland2Department of Veterinary ClinicalSciences, School of VeterinaryMedicine, Louisiana StateUniversity, Baton Rouge, LA, USA3Gastrointestinal Laboratory, TexasA&M University, College Station,TX, USA4Royal Veterinary College, London,UK

*Corresponding author. E-mail: arkkh.unibe.ch

1098-612X/09/060492+07 $34.00/0

The purpose of this study was to evaluate endosonography (EUS) as a potentialdiagnostic tool for feline pancreatitis. Eleven healthy cats and six cats diagnosedwith pancreatitis based on an increased serum feline pancreatic lipaseimmunoreactivity (fPLI) concentration were included. Transabdominalultrasound (AUS) and EUS were performed in all cats. The widths of bothpancreatic limbs and echogenicity and homogenicity were assessed by AUS andEUS. Finally, findings from both modalities were subjectively compared. In thehealthy cats, the right pancreatic limb was significantly smaller on EUScompared to AUS. Also, subjectively, general visualization of the normalpancreas was superior with EUS and, the pancreatic margins and parenchymacould be resolved better with EUS in all sick patients. In this study, EUS findingsdid not alter the diagnosis in six cats with pancreatitis when compared to AUS.However, EUS may be useful in cases where AUS fails due to obesity,hyperechoic mesentery, or excessive intestinal gas.

Date accepted: 1 November 2008 � 2008 ESFM and AAFP. Published by Elsevier Ltd. All rights reserved.

Feline pancreatitis has been shown to occur rel-atively frequently with a prevalence at nec-ropsy ranging from 1.3% to 3.5%.1,2 Also, in

a recent study of 115 cats submitted for necropsy fora variety of reasons at the University of California, Da-vis, 75.7% showed lesions consistent with acute and/or chronic pancreatitis, suggesting that as in humansand dogs, pancreatitis is more common than previ-ously suspected.3 In contrast to histopathology, thedisease often remains undiagnosed clinically asmany cats experience subclinical disease or showonly vague clinical signs.4 Currently, a variety of diag-nostic tools are being used for the diagnosis of felinepancreatitis, and all are associated with variable clin-ical usefulness. Changes in complete blood count(CBC) and serum chemistry profile are often non-spe-cific and mild. They are mainly related to concurrentdiseases or systemic complications of pancreatitis.4

Amylase and lipase activities have been shown to beof no clinical value for the diagnosis of felinepancreatitis.5 Abdominal radiographic findings arenon-specific and thus of little use.6e8 Abdominal

iane.schweighauser@

� 2008 ESFM a

ultrasonography has been shown to lack sensitiv-ity,5,7,8 with the following findings associated withfeline pancreatitis: enlarged pancreas, hypoechoic(pancreatic necrosis) or hyperechoic parenchyma (fi-brosis), surrounded by a hyperechoic mesentery (peri-pancreatic fat necrosis), peripancreatic fluidaccumulation, and pancreatic duct dilation.8e10 En-largement of the pancreas, at least in dogs, has alsobeen described in patients with hypoalbuminemiaand portal hypertension, and is thus not sufficient asa sole finding for diagnosing pancreatitis.11 The sensi-tivity of abdominal ultrasonography in feline pancre-atitis has been reported to range between 11% and35%,7,8 and to be highly operator dependent.8

A more recent study found a sensitivity of 80% incats with moderate and severe pancreatitis and a spec-ificity of 88% in healthy cats. However, in cats withclinical signs compatible with pancreatitis but no evi-dence of pancreatic disease on biopsies, the specificityof ultrasound was only 33%.12 Additionally, a normalabdominal ultrasound examination does not rule outpancreatitis.8,10 Feline serum trypsin-like immunore-activity (fTLI) assay has been shown to be highly spe-cific for exocrine pancreatic insufficiency but is notvery sensitive for the diagnosis of feline pancreatitis.13

nd AAFP. Published by Elsevier Ltd. All rights reserved.

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493Evaluation of endosonography for feline pancreatitis

One study found an overall sensitivity of 28% anda specificity of 82%.12 An initial study of feline pancre-atic lipase immunoreactivity (fPLI) concentration inserum suggested that this new test is both sensitiveand specific for the diagnosis of feline pancreatitis.The study showed a sensitivity of 100% in cats withmoderate to severe pancreatitis and 54% in mild pan-creatitis with an overall sensitivity of 67%. The speci-ficity was 100% in healthy cats and 91% for all catswithout histological evidence of pancreatitis12 usingpancreatic biopsies as a gold standard. Histologicalanalysis of pancreatic biopsies is often regarded asa gold standard for the diagnosis of pancreatitis incats.4 A big disadvantage of this method lies in thefact that pancreatic inflammation in cats may fre-quently be localized, and therefore, easily be missedon a single or even multiple biopsies.3 Finally, com-puted tomography does not appear to be useful forthe diagnosis of feline pancreatitis.7,12

Based on the promising reports from the human lit-erature14 and preliminary clinical experience with en-dosonography for evaluation of the pancreas at theSmall Animal Hospital of the University of Berne,Switzerland, this paper evaluates endosonography(EUS) as a diagnostic tool for feline pancreatitis. Theechoendoscope is similar to a conventional endoscopebut is equipped with an ultrasound transducer at itstip. When the transducer is positioned within the lu-men of the stomach, there are only a few millimetersof tissue separating it from the pancreas and there isno gas interference or loss of signal due large penetra-tion depths.15 Therefore, very detailed images can beobtained and imaging of small structures isoptimized.

The hypotheses of the current study were that endo-sonography will increase the sensitivity for detectionof pancreatic changes in cats with pancreatitis and im-prove the image quality of the feline pancreas comparedto conventional transabdominal ultrasound (AUS).

Material and methodsThe study protocol was evaluated and approved bythe Canton of Berne Animal Experimentation Com-mission (authorization number 9/03).

Symptomatic cats

Six client-owned cats with clinical signs consistentwith pancreatitis were prospectively evaluated at theUniversity of Berne Small Animal Hospital betweenNovember 2002 and February 2005 after their ownershad given informed consent.

Healthy control cats

Eleven cats from a feline colony were evaluated dur-ing the same period. None of the healthy controlcats had any previous history of gastrointestinal dis-ease and all underwent the same evaluation as thesymptomatic cats.

A complete history, physical examination, CBC, se-rum chemistry profile, serum amylase and lipase activ-ities, and urinalysis were evaluated in all cats. Serumwas collected for measurement of fTLI and fPLI con-centration. AUS and EUS were performed in all cats.

Determination of serum fPLI concentration

Serum was batched and stored at �70�C before over-night shipping on dry ice to the Gastrointestinal Lab-oratory at Texas A&M University for analysis. SerumfPLI concentrations were determined by radioimmu-noassay validated for use in the cat.13 The referencerange for fPLI was 2.0e6.8 mg/l, with concentrations�12 mg/l considered diagnostic of pancreatitis.

Transabdominal ultrasound and endosonography

All cats were examined with both AUS and EUS. Allaffected cats underwent AUS examination as part oftheir initial clinical workup, performed by one of threeboard-certified radiologists, which served as a screen-ing tool for recruiting patients for this study. Generalanesthesia was induced in all affected and healthycats after being held off food for at least 12 h within36 h of the initial examination. The protocol usedwas based on methadone (Methadon Streuli; StreuliPharma, Uznach, Switzerland) 0.2 mg IV, midazolam(Dormicum; Roche Pharma, Reinach, Switzerland)0.3 mg/kg IV, ketamine (Ketanarcon; Streuli Pharma,Uznach, Switzerland) 3e5 mg/kg IV, tracheal intuba-tion and maintenance of anesthesia with isoflurane(Isofluran Baxter; Volketswil, Switzerland). At thattime AUS was repeated and EUS examination of theabdomen was performed. Both examinations wereperformed by the same board-certified radiologist(LG) who was aware of the diagnosis that had previ-ously been made by one of two other board-certifiedradiologists or herself. However, only results for theAUS and EUS examinations performed by LG wereused for analysis in this study.

For AUS, the ventral abdomen was clipped and ul-trasound gel was applied. An Aloka Prosound ultra-sound machine (SSD-5500 ultrasound unit, Alokaholding Europe AG, Zug, Switzerland) with multifre-quency (5e10 MHz), microconvex array transducerwas used for all transabdominal examinations. Thesubjective liver size was recorded as well as hepaticechostructure and echogenicity in comparison to thespleen. The left and right limbs of the pancreas wereexamined and the mean of three measurements ofthe width of both limbs was recorded. The echogenic-ity of the peripancreatic mesentery was recorded aswell as the width of the duodenal papilla, bile duct,pancreatic duct, and gall bladder wall.

The EUS examinations were performed with a mul-tifrequency (5e10 MHz) Olympus video ultrasoundgastroscope supported by the Aloka Prosound SSD-5500 (Olympus Optical, Europa, GmbH, Hamburg,Germany) as previously described.15 After insertingthe endoscope into the stomach, the liver, pancreas,

494 A Schweighauser et al

and contiguous structures were examined and thesame parameters were recorded as during the AUSexamination.

The width of the left and right pancreatic limbs asmeasured by AUS and EUS was compared. Further-more, subjective comparisons were made as to theability to identify the pancreas with AUS versusEUS in both groups of cats.

Statistical analysis

Data were assessed for normality by the Kurtosis test.Data that were normally distributed are reported asmean� standard deviation (SD), data that were notnormally distributed are reported as medians(ranges). A ManneWhitney U test or Wilcoxon rank-sum test was used to evaluate differences betweenthe two groups of cats, and a Wilcoxon signed-ranktest was used to compare measurements of pancreaticlimb width of the same animals. Statistical signifi-cance was set at P< 0.05. For groups with less thanfive animals, only descriptive statistics were applied.

ResultsA total of 17 cats were included in this study. Therewere six client-owned cats with pancreatitis confirmedby an increased fPLI concentration, and 11 healthy con-trol cats with a serum fPLI concentration in the refer-ence range. Six cats were male (one intact and fiveneutered), and 11 female (10 intact and one spayed).Thirteen cats were domestic shorthair cats, includingall cats of the healthy control group. Other breeds in-cluded one Egyptian Mau, one Abyssinian, one Somali,and one Persian. The cats’ ages ranged from 7 to 17years (mean 11.3 years, SD 4.4) in the symptomatic

Table 1. Clinical signs and onset/duration of illness, aof the pancreas in six cats with clinical signs compa

Cat Clinical signs O

1 Lethargy Chronic with acuDehydration, icterus

2 PU/PD, vomiting Chronic with acuLethargy, anorexia,tachypnea

3 Anorexia, lethargy,abdominal pain

Acute

4 PU/PD, tenesmus Chronic with acuAnorexia, lethargy

5 Vomiting Chronic with acuAnorexia

6 Anorexia, fever Intermittent boutsAbdominal pain,lethargy,dehydration

Necropsy performed in cats 1 and 4. N/A¼ not available

group and from 2 to 12 years (mean 6.8 years, SD 3.2)in the healthy control group, which was significantlydifferent (P¼ 0.02). Clinical signs on presentation aswell as onset and duration of disease of the cats inthe symptomatic group are listed in Table 1.

CBC, chemistry panel, urinalysis and serum amylaseactivities were not different between both cat groups. Se-rum lipase was significantly higher (P¼ 0.004) in sickcats (median 37.1 U/l, range 27.6e89.8 U/l) comparedto healthy (median 23.6 U/l, range 4.0e32.0 U/l) cats(reference range: 0e83 U/l). fPLI was significantlyhigher (P¼ 0.001) in sick cats (median 27.2 mg/l, range18.3e95.9 mg/l) compared to the healthy control group(median 4.5 mg/l, range 3.4e6.4 mg/l). The referencerange for fPLI is 2.0e6.8 mg/l and the cut-off value forfPLI is >12 mg/l.

Results of the median width of the left and the rightpancreatic limb measured by EUS and AUS, com-pared between the two radiologic modalities as wellas between the sick and the healthy cats are shownin Figs 1e4. For the width of the right pancreaticlimb, the number of sick cats was too small for com-parison between EUS and AUS. Echogenicity of thepancreas for healthy and sick cats is summarized inTable 2. The pancreas appeared isoechoic to the mes-entery and was homogeneous in 9/11 healthy controlcats on both AUS and EUS. Subjectively, however, theborders of the pancreas were easier to be delineated,subjectively better margination of the left limb of thepancreas in 5/6 sick cats was possible, and the hilusof the liver and the portal vein were easier to identifywith EUS compared with AUS. This was consideredto be important as the portal vein was used as a land-mark for identifying the pancreas. Figure 5 shows theimproved delineation of the pancreatic margins ina normal cat with EUS versus AUS. Figure 6 shows

nd results of cytologic or histopathologic evaluationtible with pancreatitis

nset Cytology/histopathology

te episode Histopathology: WNL

te episode Cytology: neutrophilic andmononuclear inflammation

N/A

te episode Histopathology: WNL

te episode N/A

with acute episode N/A

, WNL¼within normal limits.

Fig 1. Width of the right pancreatic limb in millimetersmeasured by AUS compared to EUS in healthy cats (n¼ 5,P¼ 0.014).

Fig 3. Width of the left pancreatic limb in millimeters mea-sured by AUS compared to EUS in sick cats (n¼ 5, P¼ 0.75).


a similar situation in the left pancreatic limb in an af-fected cat. The pancreatic duct could only be identi-fied in 2/11 healthy control cats by AUS and was 1.0and 1.2 mm in diameter, respectively. It could be iden-tified in four healthy control cats by EUS and rangedbetween 1.0 and 2.0 mm in diameter. Using EUS thepancreatic duct could be detected in 4/6 cats withpancreatitis and diameters ranged between 1.0 and2.0 mm. In contrast, the duct could only be seen in2/6 affected cats by AUS and was 2.0 and 2.7 mm in

Fig 2. Width of the left pancreatic limb in millimeters mea-sured by AUS compared to EUS in healthy cats (n ¼ 7,P¼ 0.62).

diameter. Although the pancreatic duct could be iden-tified and measured more often by EUS, the numberof cats is too low for valid statistical comparison.The duodenal papilla could only be detected in 2/11healthy control cats with AUS and 3/11 cats withEUS. In affected cats, the papilla could be detectedin 4/6 cats with both methods. Thus, the ability toidentify the duodenal papilla was not improvedwith EUS in either healthy or affected cats.

In four affected cats, enlarged and rounded peri-portal lymph nodes were only identified during theEUS examination. In one affected cat, a fluid-filled in-tra-abdominal cavity was falsely assessed as a noduleduring the AUS examination. With EUS, the structurewas recognized to be fluid filled and was aspirated af-terwards under AUS guidance and confirmed to befluid filled by cytology. In two cats, pancreatic noduleswere identified on EUS that could not be appreciatedduring AUS (Fig 6).

The common bile duct could be identified in threehealthy control cats (diameter: median 1 mm, range0.7e1.3 mm) by AUS and in four healthy controlcats by EUS (median 2.5 mm, range 1.2e3.0 mm).The gall bladder wall thickness measured 1.0 mm inall healthy control cats with EUS whereas it rangedbetween 0.8 and 1.7 mm when measured by AUS.

The liver was found to be hyperechoic and enlargedin 5/6 sick cats and was normally sized and of normalechogenicity (hypoechoic to the spleen) in all healthycontrol cats. In one sick cat, the liver was inhomoge-neous. There was no difference in the ability to exam-ine the liver between the two ultrasound methods.

Histopathology of the pancreas was performed inthree cats of the healthy control group and revealedno abnormalities. Results of histopathology in thesick cats are summarized in Table 1.

Fig 4. Width of the left and the right pancreatic limb in millimeters measured by AUS and EUS in healthy cats (white bars)compared to sick cats (gray bars).


DiscussionThe findings of our study suggest that the left pancre-atic limb is significantly wider in sick than in healthycats when evaluated by either AUS or EUS. The sameapplies to EUS findings for the right pancreatic limbwhile the number of cats where the right pancreaticlimb was visible during AUS was too small for statis-tical analysis. This increase in size of the pancreas islikely due to inflammation and this finding was con-sistent with other studies.8 The right pancreatic limbappears significantly wider when measured by AUSin healthy cats. One possible explanation for this isthat, subjectively, the margins of the right pancreaswere easier to be delineated with EUS, whereas, cur-sor placement at the more poorly defined pancreaticmargin may have been less exact. This may have ledto an overestimation of measurements of the rightlimb of the pancreas by AUS. In contrast, in sick catsthe right pancreatic limb appeared narrower on AUSthan on EUS. However, it was only visible in 2/6sick cats on AUS, while it was identified in all sixcats using EUS. Unfortunately, these numbers weretoo small to perform a valid statistical analysis. How-ever, subjectively, the authors believed that the rightpancreatic limb could be better evaluated and mea-sured with EUS than with AUS.

Table 2. Evaluation of pancreatic echogenicityusing AUS and EUS in 11 healthy cats and insix cats with clinical signs compatible withpancreatitis

Pancreas Normal cats (n¼ 11) Sick cats (n¼ 6)

Left Right Left Right

AUS EUS AUS EUS AUS EUS AUS EUS

Normal 9 11 9 10 e e e 1Abnormal 2 e 2 e 6 6 2 4Not found e e e 1 e e 4 1

Results from our study suggest that the pancreaticmargins and parenchyma can be better resolvedwith EUS than with AUS. This appears to be duemostly to the fact that penetration depths are muchsmaller with EUS, preventing much of the artifactsthat can arise from surrounding structures. This factoris important, especially in obese or large animals, orthose with a hyperechoic mesentery. Most affected

Fig 5. Right pancreatic limb in a normal cat examined withAUS (a) and EUS (b). Note the better delineation with EUSand the discrepancy in size between the two methods.

Fig 6. Left pancreatic limb of an affected cat examined withAUS (a) and EUS (b). Arrows mark the improved delinea-tion of the pancreatic borders. Improved visualization ofthe nodules is evident.


cats in this study did have a hyperechoic mesenteryand the pancreatic margins could not be clearly iden-tified transabdominally. However, due to the nature ofthe changes in the cranial abdomen (hyperechoic mes-entery, enlarged pancreas), the diagnosis of pancreati-tis could be made transabdominally in all affectedcats. In a number of cases, details of the parenchymawere easier to see by EUS. This included a better ap-preciation of the pancreatic margins and parenchyma,regional lymph node enlargement, and of the pres-ence of nodules or fluid-filled cavities. However,EUS findings did not provide additional help for thediagnosis of pancreatitis when compared to AUS.Nevertheless, the improved visualization of nodulesand cavities changed the diagnostic strategies in onecase (cat 3 with pancreatitis), and tissue aspirationwith cytological evaluation of the specimen (cat 3),was performed. Pancreatic nodules found on EUS intwo cats were not verified surgically as no surgical

intervention was deemed necessary clinically. Addi-tionally, cats with pancreatitis often have concurrenthepatic lipidosis, a disease that may require aggres-sive treatment including placement of a feedingtube, which may be performed during the same anes-thesia as the EUS examination.

Disadvantages of EUS include anesthetic risk, ascats with severe pancreatitis may be poor anesthesiacandidates. Moreover, in cats with mild pancreatitis,elective anesthesia may seem rather invasive. EUS re-quires special equipment and a successful examina-tion requires a well-trained operator.

A significant age difference was noted betweensymptomatic and healthy cats. It is possible that catswith pancreatitis are older than healthy cats. How-ever, more likely, selecting healthy colony cats re-sulted in a younger population of cats comparedwith the hospital symptomatic population. Therewas no correlation of pancreatic width with age, andno correlation of pancreatic echogenicity with age orbody weight in a previous study,16 which leads the au-thors to the belief that the age difference did not influ-ence the imaging results in this study.

Serum lipase was significantly higher in sick catsthan in healthy cats (P¼ 0.004). This is in contrast toa previous study that did not report such a differ-ence.17 However, only one cat had a serum lipase ac-tivity that was above the upper limit of the referencerange, limiting a potential diagnostic utility of thisparameter.

fPLI was chosen as a gold standard in this study aspancreatic biopsies were not attainable in either theclient-owned cats or the control cats. Necropsy resultswere included if available. Ideally, both histopathol-ogy and fPLI would have been assessed, and the au-thors are aware of the fact, that the current goldstandard is still considered to be pancreatic histopa-thology,4 but results of initial studies concerning thesensitivity and specificity of fPLI12 should justify thischoice. Histology of the pancreas had been performedin cats 1 and 4 and showed no abnormalities. Unfortu-nately, only single sections of the pancreas were eval-uated, which represents a major limitation, aspancreatic inflammation can be localized. However,with the highly suggestive results of fPLI and bothAUS and EUS together with the clinical picture, theauthors feel confident concerning the diagnosis inthese two cases. Hepatic changes on both AUS andEUS may raise the suspicion of concurrent hepatop-athy, possibly cholangiohepatitis. However, eventhough this may not be excluded, serum chemistrychanges compatible with hepatopathy were not noted.

Another limitation is the fact that the radiologistperforming EUS (LG) was not blinded to AUS find-ings as well as the clinical suspicion. As EUS requiresanesthesia, the authors did not believe that EUS couldhave been justified without a prior suspicion of pan-creatitis. However, an AUS examination was per-formed by this same radiologist (LG) as the EUSexamination, and thus allowed direct comparison of


the two modalities by the same sonographer, whichwas one of the main points of interest in this study.

In summary, in control cats, both AUS and EUSshow subjectively similar results for the feline pan-creas in terms of size and echogenicity. However,EUS may be superior for imaging the pancreas withincreased resolution in obese cats when AUS failsdue to large penetration depths or air artifacts.

AcknowledgmentsThe authors would like to thank Patrick Kircher,Division of Radiology, Vetsuisse Faculty, Universityof Berne, Switzerland, for his valuable help.

References1. Owens JM, Drazner FH, Gilbertson SR. Pancreatic dis-

ease in the cat. J Am Anim Hosp Assoc 1975; 11: 83e9.2. Hanichen T, Minkus G. Retrospektive Studie zur Patho-

logie der Erkrankungen des exokrinen Pankreas beiHund und Katze. Tierarztl Umsch 1990; 45: 363e8.

3. De Cock HE, Forman MA, Farver TB, Marks SL. Preva-lence and histopathologic characteristics of pancreatitisin cats. Vet Pathol 2007; 44: 39e49.

4. Steiner JM, Williams DA. Feline exocrine pancreatic dis-orders. Vet Clin North Am Small Anim Pract 1999; 29:551e75.

5. Steiner JM. Diagnosis of pancreatitis. Vet Clin North AmSmall Anim Pract 2003; 33: 1181e95.

6. Hill RC, Van Winkle TJ. Acute necrotizing pancreatitisand acute suppurative pancreatitis in the cat. A retro-spective study of 40 cases (1976e1989). J Vet Intern Med1993; 7: 25e33.

7. Gerhardt A, Steiner JM, Williams DA. Comparison of thesensitivity of different diagnostic tests for pancreatitis incats. J Vet Intern Med 2001; 15: 329e33.

8. Saunders HM, VanWinkle TJ, Drobatz K, Kimmel SE,Washabau RJ. Ultrasonographic findings in cats withclinical, gross pathologic, and histologic evidence ofacute pancreatic necrosis: 20 cases (1994e2001). J AmVet Med Assoc 2002; 221: 1724e30.

9. Wall M, Biller DS, Schoning P, Olsen D, Moore LE. Pan-creatitis in a cat demonstrating pancreatic duct dilatationultrasonographically. J Am Anim Hosp Assoc 2001; 37:49e53.

10. Hecht S, Henry G. Sonographic evaluation of the normaland abnormal pancreas. Clin Tech Small Anim Pract 2007;22: 115e21.

11. Lamb CR. Pancreatic edema in dogs with hypoalbumi-nemia or portal hypertension. J Vet Int Med 1999; 13:498e500.

12. Forman MA, Marks SL, De Cock HE, et al. Evaluation ofserum feline pancreatic lipase immunoreactivity and he-lical computed tomography versus conventional testingfor the diagnosis of feline pancreatitis. J Vet Intern Med2004; 18: 807e15.

13. Steiner JM, Wilson BG, Williams DA. Development andanalytical validation of a radiommunoassay for the mea-surement of feline pancreatic lipase immunoreactivity inserum. Can J Vet Res 2004; 68: 309e14.

14. Tandon M, Topazian M. Endoscopic ultrasound in idio-pathic acute pancreatitis. Am J Gastroenterol 2002; 97:1244e6.

15. Gaschen L, Kircher P, Lang J. Endoscopic ultrasound in-strumentation, applications in humans, and potentialveterinary applications. Vet Radiol Ultrasound 2003; 44:665e80.

16. Moon Larson M, Panciera DL, Ward DL, Steiner JM, Wil-liams DA. Age-related changes in the ultrasound ap-pearance of the normal feline pancreas. Vet RadiolUltrasound 2005; 46(3): 238e42.

17. Parent C, Washabau RJ, Williams DA, et al. Serum tryp-sin-like immunoreactivity, amylase and lipase in the di-agnosis of feline acute pancreatitis. [abstract]. J Vet InternMed 1995; 9(3): 194.

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evaluation of endosonography as a new diagnostic tool for feline pancreatitis

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