A prospective comparison of the yield of EUS in primary vs. recurrent idiopathic acute pancreatitis

Yusoff, Ian F.; Raymond, Ginette; Sahai, Anand V.

doi:10.1016/s0016-5107(04)02018-8

Cited by 134 publications

(103 citation statements)

References 26 publications

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“…In our small series two patients were diagnosed with this disorder -one diagnosis was made MRCP and EUS, and both cases were suspected using the latter exploration, which highlights the importance of this procedure in the context of pancreatic diseases of unknown etiology (9). Case 2 is recurrent acute pancreatitis that finally led to the development of chronic pancreatitis, supporting Whitcomb´s SAPE hypothesis (10).…”

Section: Discussionmentioning

confidence: 54%

“…En nuestra serie dos de las mujeres han sido diagnosticadas de PC. Uno de los diagnósticos ha sido alcanzado mediante CPRM y USE, y sospechado en los dos casos gracias a esta última exploración, lo que resalta la importancia de este procedimiento en el contexto de enfermedades pancreáticas de etiología incierta (9). El caso número 2 muestra una pancreatitis aguda recidivante que finalmente desemboca en PC, apoyando la SAPE hipótesis (necrosis-fibrosis) de Whitcomb (10).…”

Section: Discussionunclassified

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Pancreatitis and systemic lupus erythematosus

Noia

García

Rı́os

et al. 2009

Rev. esp. enferm. dig.

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Gastrointestinal symptoms in patients with SLE are common, specifically abdominal pain. However, the rate of pancreatic diseases is much lower and does not reach 5% according to published series in Europe and the USA. This association between SLE and pancreatic disease is basically at the expense of episodes of acute pancreatitis. An association with chronic pancreatitis is much more uncommon, and only four articles have been published showing this relationship.Three cases of SLE-associated pancreatitis are described, and disease onset, etiological factors, and clinical progression are analyzed. A review of the literature and a brief discussion about pathophysiological mechanisms and the role of corticosteroids are also included.Key words: Systemic lupus erythematosus. Acute pancreatitis. Chronic pancreatitis. INTRODUCTIONSince the first association between systemic lupus erythematosus (SLE) and pancreatitis was documented by Reifenstein et al. in 1939 (1), very few reports about the prevalence of pancreatic diseases in this rheumatologic disorder have been reported.Gastrointestinal symptoms in patients with SLE are common, specifically abdominal pain; as described in some series, it has been shown to have a prevalence of 19.2% (2). The rate of pancreatitis in patients with SLE varies depending on individual series from Europe and the United States between 0.7 and 4% (3,4). This association is mainly at the expense of acute episodes of pancreatitis; however only four reports have been published regarding this relationship with chronic pancreatitis (5-7).Three cases of SLE-associated pancreatitis are described, and disease onset, etiological factors and clinical progression are analyzed. A review of the literature and a brief discussion about the pathophysiological mechanisms and the role of corticosteroids are also included. METHODSA retrospective review of hospital admissions at Gastroenterology Department, University Hospital, Santiago de Compostela during 2001-2005 with the dual diagnosis of systemic lupus erythematosus and pancreatitis was made. Demographic data, clinical intervention, and progression parameters of pancreatic disease were identified. These patients were collected by searching our institution's computer database using the key words "pancreatitis" and "SLE". Demographic information registered from the medical charts included subject age, gender, time (years) from the initial diagnosis of SLE, alcohol abuse, medications, specially corticosteroids, and criteria used for SLE diagnosis.Clinical data collected included symptoms, SLE activity with a list of organs or systems involved, initial pancreatic enzymes, number of admissions for pancreatitis, and serologies for antinuclear antibodies (ANA) and C-reactive protein levels. All radiological results were documented, including abdominal ultrasounds, helical CT, cholangiopancreatic resonance (MRPC), endoscopic retrograde cholangiopancreatography (ERPC), and endoscopic ultrasounds (EUS

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Section: Discussionmentioning

confidence: 54%

Section: Discussionunclassified

Pancreatitis and systemic lupus erythematosus

Noia

García

Rı́os

et al. 2009

Rev. esp. enferm. dig.

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“…Endoscopic ultrasound has become a popular alternative for further diagnostic testing due to its higher sensitivity for microlithiasis and sludge [9] . (Table 1) EUS also has the advantage of evaluating several alternative causes for AIP including pancreas divisum, neoplasms, and undiagnosed chronic pancreatitis [10] . T herapy for microlithiasis/sludg e is g enerally laparoscopic cholecystectomy although endoscopic biliary sphincterotomy in the poor operative candidate [11] or longterm treatment with ursodeoxycholic acid [3] are alternatives.…”

Section: Gallbladder In Situmentioning

confidence: 99%

Sphincter of Oddi dysfunction and bile duct microlithiasis in acute idiopathic pancreatitis

Elta

2008

WJG

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Although there are numerous causes of acute pancreatitis, an etiology cannot always be found. Two potential etiologies, microlithiasis and sphincter of Oddi dysfunction, are discussed in this review. Gallbladder microlithiasis, missed on transcutaneous ultrasound, is reported as the cause of idiopathic acute pancreatitis in a wide frequency range of 6%-80%. The best diagnostic technique for gallbladder microlithiasis is endoscopic ultrasound although biliary crystal analysis and empiric cholecystectomy remain as reasonable options. In contrast, in patients who are post-cholecystectomy, bile duct microlithiasis does not appear to have a role in the pathogenesis of acute pancreatitis. Sphincter of Oddi dysfunction is present in 30%-65% of patients with idiopathic acute recurrent pancreatitis in whom other diagnoses have been excluded. It is unclear if this sphincter dysfunction was the original etiology of the first episode of pancreatitis although it appears to have a causative role in recurring episodes since sphincter ablation decreases the frequency of recurrent attacks. Unfortunately, this conclusion is primarily based on small retrospective case series; larger prospective studies of the outcome of pancreatic sphincterotomy for SOD-associated acute pancreatitis are sorely needed. Another problem with this diagnosis and its treatment is the concern over potential procedure related complications from endoscopic retrograde cholangiopancreatography (ERCP), manometry and pancreatic sphincterotomy. For these reasons, patients should have recurrent acute pancreatitis, not a single episode, and have a careful informed consent before assessment of the sphincter of Oddi is undertaken.

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“…The recurrences of pancreatitis in these patients are quite likely the expression of a chronic disease ab initio. The frequency of the diagnosis of CP in patients with ARP, on the basis of EUS criteria, ranges from 10% to 30% [25,26] . Prospective randomized studies on ARP patients and controls, matched for sex and age, are therefore still needed to further verify the value of these criteria for this diagnosis.…”

Section: Idiopathic Pancreatitismentioning

confidence: 99%

Is acute recurrent pancreatitis a chronic disease?

Mariani¹,

Testoni²

2008

WJG

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Whether acute recurrent pancreatitis is a chronic disease is still debated and a consensus is not still reached as demonstrated by differences in the classification of acute recurrent pancreatitis. There is major evidence for considering alcoholic pancreatitis as a chronic disease ab initio while chronic pancreatitis lesions detectable in biliary acute recurrent pancreatitis (ARP) seem a casual association. Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation, hereditary and obstructive pancreatitis seem an acute disease that progress to chronic pancreatitis, likely as a consequence of the activation and proliferation of pancreatic stellate cells that produce and activate collagen and therefore fibrosis. From the diagnostic point of view, in patients with acute recurrent pancreatitis Endoscopic ultrasound (EUS) seems the more reliable technique for an accurate evaluation and follow-up of some ductal and parenchymal abnormalities suspected for early chronic pancreatitis. THE CLASSIFICATION PROBLEMAcute recurrent pancreatitis (ARP) is defined as the presence of at least two documented episodes of pancreatitis in a patient without chronic pancreatitis (CP) at imaging. The classification, however, is still a debated and controversial issue. Is this a relapsing acute disease with restitutio ad integrum of the pancreatic gland when the cause is eliminated or does it progress to chronic disease when the cause is not removed? There is also debate about whether ARP is actually a chronic disease ab initio, regardless of whether the cause persists, so that recurrences of pancreatitis are the clinical expression of CP in an early phase.The term ARP was reported in the first Marseille classification of pancreatitis [1] that strictly divided ARP from CP. ARP is also reported in the classification of TIGAROt [2] , so-called from the acronym of the major predisposing risk factors, but was eliminated in the revised classifications of Marseille [3] and Marseille-Rome [4] because of the difficulties of distinguishing between a relapse of acute pancreatitis (AP) and an exacerbation of CP. In the paper referring to the Marseille-Rome classification the majority of the authors commented that the progression of acute to chronic pancreatitis was extremely uncommon.In contrast, when pancreatitis is interpreted as a "hydraulic" obstructive problem, as a consequence of ductal lesions secondary to periductal inflammatory infiltrates [5] or post-necrotic scars [6,7] , ARP can develop into CP over time if the cause of the disease persists. According to these pathogenic hypotheses, backed by experimental findings, the duration and grade of the pancreatic ductal obstruction are pivotal factors for differentiating the types of pancreatitis: partial, temporary pancreatic ductal obstruction (e.g. biliary lithiasis in humans) can lead to AP, while partial but longlasting obstruction (e.g. stenosis of Oddi's sphincter or the Wirsung duct) is a cause of CP. When the ductal obstruction is complete and long-lasting (e.g. n...

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A prospective comparison of the yield of EUS in primary vs. recurrent idiopathic acute pancreatitis

Cited by 134 publications

References 26 publications

Pancreatitis and systemic lupus erythematosus

Pancreatitis and systemic lupus erythematosus

Sphincter of Oddi dysfunction and bile duct microlithiasis in acute idiopathic pancreatitis

Is acute recurrent pancreatitis a chronic disease?

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