Role of endoscopic ultrasonography in the diagnostic work-up of idiopathic acute pancreatitis (PICUS): study protocol for a nationwide prospective cohort study

Umans, Devica S; Timmerhuis, Hester C.; Hallensleben, Nora D L; Bouwense, Stefan; Anten, Marie-Paule; Bhalla, Abha; Bijlsma, Rina; Boermeester, Marja A.; Brink, Menno A.; Hol, Lieke; Bruno, Marco J.; Curvers, Wouter L.; Dullemen, Hendrik M. van; Eijck, Brechje C van; Erkelens, G Willemien; Fockens, Paul; Geenen, Erwin J M van; Hazen, Wouter; Hoge, Chantal; Inderson, Akin; Kager, Liesbeth M.; Kuiken, Sjoerd D.; Perk, Lars E; Poley, Jan–Werner; Quispel, Rutger; Römkens, Tessa E H; Santvoort, Hjalmar C. van; Tan, Adriaan C.; Thijssen, Ayla; Venneman, Niels G.; Vleggaar, Frank P.; Voorburg, A.; Wanrooij, Roy L. van; Witteman, Ben J.M.; Verdonk, Robert C.; Besselink, Marc G.; Hooft, Jeanin E. van

doi:10.1136/bmjopen-2019-035504

Cited by 13 publications

(7 citation statements)

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“…This may raise the question whether follow‐up imaging would allow for an earlier diagnosis in idiopathic pancreatitis patients. As follow‐up imaging has previously been proposed for these patients to further investigate etiology and identify the need of a cholecystectomy, screening for pancreatic cancer may be another indication 28,29 …”

Section: Discussionmentioning

confidence: 99%

“…As follow-up imaging has previously been proposed for these patients to further investigate etiology and identify the need of a cholecystectomy, screening for pancreatic cancer may be another indication. 28,29 Several important findings emerged from our data when examining risk factors for disease transition. Consistent with other studies, the highest cumulative incidence of RAP and CP was observed among alcoholic pancreatitis patients.…”

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confidence: 80%

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Development of pancreatic diseases during long‐term follow‐up after acute pancreatitis: a post‐hoc analysis of a prospective multicenter cohort

de Rijk,

Sissingh,

Boel

et al. 2024

J of Gastro and Hepatol

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Background and AimMore insight into the incidence of and factors associated with progression following a first episode of acute pancreatitis (AP) would offer opportunities for improvements in disease management and patient counseling.MethodsA long‐term post hoc analysis of a prospective cohort of patients with AP (2008–2015) was performed. Primary endpoints were recurrent acute pancreatitis (RAP), chronic pancreatitis (CP), and pancreatic cancer. Cumulative incidence calculations and risk analyses were performed.ResultsOverall, 1184 patients with a median follow‐up of 9 years (IQR: 7–11) were included. RAP and CP occurred in 301 patients (25%) and 72 patients (6%), with the highest incidences observed for alcoholic pancreatitis (40% and 22%). Pancreatic cancer was diagnosed in 14 patients (1%). Predictive factors for RAP were alcoholic and idiopathic pancreatitis (OR 2.70, 95% CI 1.51–4.82 and OR 2.06, 95% CI 1.40–3.02), and no pancreatic interventions (OR 1.82, 95% CI 1.10–3.01). Non‐biliary etiology (alcohol: OR 5.24, 95% CI 1.94–14.16, idiopathic: OR 4.57, 95% CI 2.05–10.16, and other: OR 2.97, 95% CI 1.11–7.94), RAP (OR 4.93, 95% CI 2.84–8.58), prior pancreatic interventions (OR 3.10, 95% CI 1.20–8.02), smoking (OR 2.33, 95% CI 1.14–4.78), and male sex (OR 2.06, 95% CI 1.05–4.05) were independently associated with CP.ConclusionDisease progression was observed in a quarter of pancreatitis patients. We identified several risk factors that may be helpful to devise personalized strategies with the intention to reduce the impact of disease progression in patients with AP.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 80%

Development of pancreatic diseases during long‐term follow‐up after acute pancreatitis: a post‐hoc analysis of a prospective multicenter cohort

de Rijk,

Sissingh,

Boel

et al. 2024

J of Gastro and Hepatol

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“…Not infrequently, the underlying cause of an acute pancreatitis episode remains obscure even after standard clinical, biochemical, and radiological (US and CT) evaluation, creating a subgroup of acute pancreatitis referred to as acute idiopathic pancreatitis (AIP) [ 25 ]. Previous studies have shown that an EUS examination might be beneficial in exploring the underlying cause of a presumed AIP [ 26 ]. During an episode of AIP, the yield of EUS in exploring the pancreatic parenchyma and ducts is very limited given the presence of edema of the duodenal wall, pancreatic inflammation, necrosis, or peri-pancreatic fluid collection, as these can deeply hinder the visualization of the pancreas, and occasionally the gallbladder or bile duct.…”

Section: Discussionmentioning

confidence: 99%

Exploring the Optimal Timing of Endoscopic Ultrasound Performance Post-Acute Idiopathic Pancreatitis

2022

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Background: Patients with acute idiopathic pancreatitis (AIP) should undergo further imaging tests such as endoscopic ultrasound (EUS) for further investigation. The time interval between an episode of AIP and EUS performance is still controversial. Aims: We aimed to explore the optimal timing for performing EUS and to reveal parameters that might predict longer intervals needed for performing EUS. Methods: We performed a single-center retrospective study at Galilee Medical Center from January 2015 to January 2020, at which point we included all patients who underwent EUS for further investigation of AIP. Results: Overall, we included 50 patients. The average age of all patients was 54.2 ± 17.6 years (range 22–69 years), and more than half of the study cohort were males (58%). Classifying patients as inflamed vs. normal pancreatic tissue on EUS, we found that among patients with normal pancreatic tissue, EUS was performed 44.7 ± 28.3 days from discharge, while for patients with inflamed pancreatic tissue, it was 48.1 ± 22.3 days (p = 0.37) after discharge. Notably, the CT severity index was significantly associated with inflamed pancreatic tissue on EUS, as it was 2.4 ± 0.74 vs. 1.5 ± 1.3 in the normal pancreatic tissue group (p = 0.03). There were no differences in the Bedside index for severity in acute pancreatitis (BISAP) scores, and there were no differences in the average American Society of Anesthesiologist Physical Status (ASA) scores between the two groups. Notably, 26.3% of patients had inflamed pancreatic tissue when performing EUS at 4 weeks, as compared to 16% who had inflamed pancreatic tissue at EUS performed after 6 weeks. Conclusion: Radiological severity score was the only important factor in determining the time interval of performing EUS after an episode of AIP. Intervals greater than six weeks seem to be needed among patients with higher Balthazar scores.

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“…All patients provided written informed consent. The study protocol was registered at the Netherlands Trial Registry (NL7066) and published 10 . This study was reported in accordance with the STROBE statement for cohort studies 11 and the STARD statement 12 ( Table S1 ).…”

Section: Methodsmentioning

confidence: 99%

Prospective multicentre study of indications for surgery in patients with idiopathic acute pancreatitis following endoscopic ultrasonography (PICUS)

Umans,

Timmerhuis,

Anten

et al. 2023

British Journal of Surgery

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Background Cholecystectomy in patients with idiopathic acute pancreatitis (IAP) is controversial. A randomized trial found cholecystectomy to reduce the recurrence rate of IAP but did not include preoperative endoscopic ultrasonography (EUS). As EUS is effective in detecting gallstone disease, cholecystectomy may be indicated only in patients with gallstone disease. This study aimed to determine the diagnostic value of EUS in patients with IAP, and the rate of recurrent pancreatitis in patients in whom EUS could not determine the aetiology (EUS-negative IAP). Methods This prospective multicentre cohort study included patients with a first episode of IAP who underwent outpatient EUS. The primary outcome was detection of aetiology by EUS. Secondary outcomes included adverse events after EUS, recurrence of pancreatitis, and quality of life during 1-year follow-up. Results After screening 957 consecutive patients with acute pancreatitis from 24 centres, 105 patients with IAP were included and underwent EUS. In 34 patients (32 per cent), EUS detected an aetiology: (micro)lithiasis and biliary sludge (23.8 per cent), chronic pancreatitis (6.7 per cent), and neoplasms (2.9 per cent); 2 of the latter patients underwent pancreatoduodenectomy. During 1-year follow-up, the pancreatitis recurrence rate was 17 per cent (12 of 71) among patients with EUS-negative IAP versus 6 per cent (2 of 34) among those with positive EUS. Recurrent pancreatitis was associated with poorer quality of life. Conclusion EUS detected an aetiology in a one-third of patients with a first episode of IAP, requiring mostly cholecystectomy or pancreatoduodenectomy. The role of cholecystectomy in patients with EUS-negative IAP remains uncertain and warrants further study.

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Role of endoscopic ultrasonography in the diagnostic work-up of idiopathic acute pancreatitis (PICUS): study protocol for a nationwide prospective cohort study

Cited by 13 publications

References 57 publications

Development of pancreatic diseases during long‐term follow‐up after acute pancreatitis: a post‐hoc analysis of a prospective multicenter cohort

Development of pancreatic diseases during long‐term follow‐up after acute pancreatitis: a post‐hoc analysis of a prospective multicenter cohort

Exploring the Optimal Timing of Endoscopic Ultrasound Performance Post-Acute Idiopathic Pancreatitis

Prospective multicentre study of indications for surgery in patients with idiopathic acute pancreatitis following endoscopic ultrasonography (PICUS)

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