The diagnosis of autoimmune pancreatitis (AIP) remains a challenging test of our clinical skills. This difficulty is further compounded by lack of universally accepted criteria for its diagnosis. For the past decade, many different diagnostic criteria for AIP have been reported from Asia, Europe, and North America. The lack of consensus to date on diagnostic criteria for AIP can be traced to 2 basic reasons. First, the practice patterns in the usage of various tests and perceived accuracy of these tests for diagnosis of AIP vary considerably worldwide. For example, endoscopic retrograde pancreatogram is routinely used for investigating obstructive jaundice in Japan and is a mandatory criterion in the Japanese criteria. However, Western endoscopists generally avoid injecting the pancreatic duct in patients with obstructive jaundice for fear of causing pancreatitis, and AIP in the West is diagnosed without a requirement for endoscopic retrograde pancreatography (ERP). Similarly, core biopsy of the pancreas to diagnose AIP has been championed by the Mayo Clinic group but is not routinely used elsewhere.
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