Prospective evaluation of yield of endoscopic ultrasonography in the etiological diagnosis of "idiopathic" acute pancreatitis

Abstract

Background: Etiology of acute pancreatitis (AP) remains idiopathic in 30% of patients. Endoscopic ultrasound (EUS) has been shown to increase the diagnostic yield in patients with idiopathic AP (IAP). Aim: The aim of this study was to evaluate the role of EUS in achieving etiological diagnosis in patients with IAP. Materials and Methods: Consecutive 192 patients with IAP were evaluated prospectively with EUS over a period of 2 years. Patients who had no etiological diagnosis for AP after detailed history, clinical examination, laboratory investigations, and magnetic resonance cholangiopancreatography were included in the study. Results: The mean age of patients was 34.6 ± 12 and male:female ratio was 2.1:1. Of these, 135 patients had gallbladder intact (Group A) and 57 patients had undergone cholecystectomy (Group B). In Group A, EUS identified a possible cause in 79 (58.5%) patients; microlithiasis (n = 48), chronic pancreatitis (CP) (n = 23), common bile duct (CBD) and gallbladder stone (n = 3), pancreatic divisum (n = 3), small pancreatic tumor (n = 1), and anomalous pancreaticobiliary junction (n = 1). In Group B, EUS yielded diagnosis in 28 (49.1%) patients; CP (n = 22), ascariasis (n = 3), CBD stone (n = 2), and pancreatic divisum (n = 1). Overall EUS helped in achieving etiological diagnosis in 107 (55.1%) of patients with IAP. The presence of intact gallbladder showed a tendency for increased diagnostic yield (P = 0.06). Conclusion: EUS is a useful modality to establish the diagnosis in IAP and this technique should be incorporated in the evaluation of IAP.

Idiopathic Acute Pancreatitis (IAP): The Value of Endoscopic Ultrasound

“…Moreover, 67 patients were below 40 years of age while 42 patients were above 40 years of age with good significance (P=0.01). It shows idiopathic acute pancreatitis is more common in young age which is consistent with previous studies (Elzouki et al, 2019).In foregone studies, among the patients of idiopathic acute pancreatitis about 20-50% presented with microlithiasis (Liu et al, 2000;Ros et al, 1991;Dill & Dill, 2002;Lee & Nicholls, 1986;Levy, 2002) , 15% with chronic pancreatitis (Wilcox & Kilgore, 2009), 25% with common bile duct stone (Choudhary et al, 2016) and about 3.2% with pancreatic cancer (Tandon & Topazian, 2001). Our study almost resembled those previously found data.…”

“…Patients with operated gall bladder showed common bile duct stone (24.6%) and biliary ascariasis (21.4%) as the leading causes in our study. But Choudhary NS et al showed early chronic pancreatitis (38.6%) as the main cause of idiopathic acute pancreatitis in patients who underwent cholecystectomy (Choudhary et al, 2016). Khuroo MS and associates showed that biliary ascariasis is found in 23% of acute pancreatitis patients in South East Asia which is 21.4% in our study (Khuroo et al, 2016).…”