Should ERCP be routine after an episode of “idiopathic” pancreatitis? A cost-utility analysis

Gregor, James C.; Ponich, Terry; Detsky, Allan S.

doi:10.1016/s0016-5107(96)70127-x

Cited by 44 publications

(17 citation statements)

References 28 publications

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“…It has been suggested that routine ERCP may be of marginal benefit in what may be an attack of 'idiopathic pancreatitis' 52 . However, recent advances in EUS and magnetic resonance cholangiopancreatography (MRCP) must call into question the role of diagnostic ERCP, especially considering its potentially serious associated complications 37,53 -55 .…”

Section: Endoscopic Retrograde Cholangiopancreatographymentioning

confidence: 99%

Management of severe acute pancreatitis

Yousaf

McCallion

Diamond

2003

British Journal of Surgery

136

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Recent evidence has helped to clarify the roles of computed tomography, endoscopic retrograde cholangiopancreatography, prophylactic antibiotics, enteral feeding and fine-needle aspiration for bacteriology in the management of acute pancreatitis. Despite a relative shortage of prospective randomized trials there has been a significant change in the surgical management of acute pancreatitis over the past 20 years. This change has been away from early aggressive surgical intervention towards more conservative management, except when infected necrosis is confirmed. A formalized approach, with appropriate use of the various non-surgical and surgical options, is feasible in the management of severe acute pancreatitis.

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Section: Endoscopic Retrograde Cholangiopancreatographymentioning

confidence: 99%

Management of severe acute pancreatitis

Yousaf

McCallion

Diamond

2003

British Journal of Surgery

136

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“…ERCP reveals a diagnosis in about 70% of patients with IARP after a negative initial evaluation (1,15). Because the initial episode of pancreatitis may be an isolated event and because of the risk of ERCP, most agree that this procedure is not justified after the first episode of pancreatitis (37,147). Many believe, however, that ERCP is indicated when the first episode is severe or when a patient has two or more episodes.…”

Section: Ajg -September 2001mentioning

confidence: 99%

Idiopathic acute recurrent pancreatitis

Levy¹,

Geenen²

2001

Am J Gastroenterology

120

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Acute recurrent pancreatitis (ARP) results most commonly from alcohol abuse or gallstone disease. Initial evaluation fails to detect the cause of ARP in 10-30% of patients, and as a result the diagnosis of "idiopathic" ARP is given. In these patients, a more extensive evaluation including specialized labs, ERCP, endoscopic ultrasound, or magnetic resonance cholangiopancreatography typically leads to a diagnosis of microlithiasis, sphincter of Oddi dysfunction, or pancreas divisum. Less commonly, hereditary pancreatitis, cystic fibrosis, a choledochocele, annular pancreas, an anomalous pancreatobiliary junction, pancreatobiliary tumors, or chronic pancreatitis are diagnosed. Determining the etiology is important, as it helps to direct therapy, limits further unnecessary evaluation, and may improve a patient's long term prognosis.

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“…pancreatitis (CP) is common in those with recurrent attacks who have previously undergone cholecystectomy. [10] Microscopic examination of bile, [10,11] endoscopic retrograde cholangiopancreatography (ERCP), [11,12] and magnetic resonance cholangiopancreatography (MRCP) [13] have been used to find etiology in these cases; however, ERCP has some chances of complications and MRCP is inferior to EUS in detecting <5 mm stones. [14,15] EUS offers several advantages over these modalities; it provides better resolution to diagnose small stones/tumors [1] and CP.…”

Section: Introductionmentioning

confidence: 99%

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

Choudhary

Bansal

Shah

et al. 2016

Journal of Digestive Endoscopy

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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.

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Should ERCP be routine after an episode of “idiopathic” pancreatitis? A cost-utility analysis

Cited by 44 publications

References 28 publications

Management of severe acute pancreatitis

Management of severe acute pancreatitis

Idiopathic acute recurrent pancreatitis

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

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