Emerging Role of Endoscopic Ultrasound in the Diagnostic Evaluation of Idiopathic Pancreatitis

Smith, Ioana; Ramesh, Jayapal; Baig, Kondal R. Kyanam Kabir; Mönkemüller, Klaus; Wilcox, C. Mel

doi:10.1097/maj.0000000000000541

Cited by 30 publications

(29 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In ~10-20% of cases, no cause can be established aft er routine investigation ( 5,6 ), and the additional evaluation, which should be undertaken following an initial negative work-up, remains undefi ned ( 5,(7)(8)(9). When idiopathic pancreatitis recurs, additional investigation is typically performed, such as magnetic resonance cholangiopancreatography, endoscopic ultrasound (EUS), or endoscopic retrograde cholangiopancreatography (ERCP); however, which test(s) to perform is not standardized.…”

Section: Introductionmentioning

confidence: 99%

Prospective Endoscopic Ultrasound-Based Approach to the Evaluation of Idiopathic Pancreatitis: Causes, Response to Therapy, and Long-term Outcome

Wilcox

Seay

Kim

et al. 2016

American Journal of Gastroenterology

View full text Add to dashboard Cite

OBJECTIVES:Although idiopathic pancreatitis is common, the natural history is not well studied, and the best diagnostic approach to both single and multiple attacks remains undefi ned. METHODS:We prospectively evaluated patients with idiopathic pancreatitis over a 10-year period, and clinical information for each episode was reviewed. Endoscopic ultrasound (EUS) was performed in all patients. Patients with microlithiasis or bile duct stones were referred for cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP), respectively. For those with a single attack, if EUS was normal or chronic pancreatitis or pancreas divisum was diagnosed, the patient was followed up for recurrence. For those with multiple attacks and a negative EUS, ERCP and sphincter of Oddi manometry with endoscopic therapy as appropriate were recommended. All patients were followed up in the long term to evaluate for recurrent pancreatitis, the primary study end point. RESULTS:Over the study period, 201 patients were identifi ed (80 single attack, 121 multiple attacks; mean age 53 years, range 17-95 years, s.d. 16.3 years; and 53% female). After EUS, 54% of patients with a single attack were categorized as idiopathic, and for multiple attacks sphincter of Oddi dysfunction (SOD) was the most common diagnosis (41%). Long-term follow-up (median 37 months; interquartile range 19-70 months) documented recurrence of pancreatitis in 15 (24%; 95% confi dence interval (CI), 15-38%) patients with a single attack and in 48 (49%; 95% CI, 38-62%) patients with multiple attacks. Despite endoscopic therapy, patients with pancreas divisum and SOD had relapse rates of 50% (95% CI, 35 to 68%) and 55% (95% CI, 31 to 82%), respectively. CONCLUSIONS: Following a single idiopathic attack of pancreatitis and a negative EUS examination, relapse was infrequent. Despite endoscopic therapy, patients with multiple attacks, especially those attributed to pancreas divisum and SOD, had high rates of recurrence. EUS may be a useful, minimally invasive tool for the diagnostic evaluation of idiopathic pancreatitis. The study was listed in Clinicaltrials.gov NCT00609726.

show abstract

Section: Introductionmentioning

confidence: 99%

Prospective Endoscopic Ultrasound-Based Approach to the Evaluation of Idiopathic Pancreatitis: Causes, Response to Therapy, and Long-term Outcome

Wilcox

Seay

Kim

et al. 2016

American Journal of Gastroenterology

View full text Add to dashboard Cite

show abstract

“…In the absence of cholelithiasis, a cholangio-NMR or CT is performed (1). In the cases of idiopathic pancreatitis, the endoscopy ultrasound has special interest as it is the most sensitive test to rule out microlithiasis or biliary sludge (10).…”

Section: Discussionmentioning

confidence: 99%

Case of drug-induced acute pancreatitis produced by horsetail infusions

et al. 2017

View full text Add to dashboard Cite

Introduction:The most frequent causes of acute pancreatitis are biliary stones, alcohol consumption, smoking and tumors. Some of them do not have any established cause, and they are catalogued as idiopathic pancreatitis.Case report: We report the case of a 56-year-old woman with a history of bilateral adrenalectomy on hormone replacement therapy with corticosteroids, who has recurrent episodes of mild acute pancreatitis with an etiologic study (laboratory and imaging tests) without significant findings. A drug-induced etiology was suspected, so corticosteroids were removed and antihypertensive treatment was modified, but the clinical manifestations persisted. Later regular consumption of horsetail infusions was detected, and after their suspension the patient became asymptomatic and has not presented new episodes.Discussion: The drug-induced acute pancreatitis is a strange cause of pancreatitis that is frequently underdiagnosed because of the difficulty to establish a relationship between the drugs and the pancreatitis. Lots of drugs have been related with acute pancreatitis, while the information available for herbal products is limited. They usually present like mild and recurrent episodes, without significant findings in both laboratory and imaging tests (abdominal ultrasound, abdominal computed tomography [CT], cholangiography and endoscopic ultrasound). It is important to detect the origin of this type of pancreatitis to prevent recurrence.

show abstract

“…Chronic pancreatitis, identified by EUS, is emerging as an important and potential cause of RIP, although EUS may be lack of specificity in the diagnosis of chronic pancreatitis if secretin stimulation testing is used as the gold standard. Preliminary observations indicate that EUS may decrease the need for ERCP through the identification of microlithiasis and chronic pancreatitis [11,13].…”

Section: Eus and Gallbladder Microlithiasismentioning

confidence: 99%

“…Microlithiasis in the gallbladder may be undetected by transabdominal ultrasound and rarely detected on other imaging modalities including multidetector computed tomography (CT) and magnetic resonance imaging (MRI). In some patients with microlithiasis, biliary sludge and/or gallstones can be detected by EUS, with its high spatial resolution [9][10][11].…”

Section: Eus and Gallbladder Microlithiasismentioning

confidence: 99%

“…Recent studies have suggested that microlithiasis is a cause of unexplained pancreatitis in up to 75% of patients with an intact gallbladder [11,12]. Given the high incidence of microlithiasis and/or biliary sludge as a cause of idiopathic pancreatitis and high accuracy of EUS for recognizing these diagnoses, EUS should be considered as a minimally invasive highly accurate diagnostic tool for idiopathic pancreatitis after conventional radiography fails (Figure 1).…”

Section: Eus and Gallbladder Microlithiasismentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic Ultrasonography (EUS) and Gallbladder

Alizadeh¹

2017

Updates in Gallbladder Diseases

View full text Add to dashboard Cite

Diseases of the gallbladder commonly manifest as cholelithiasis and gallbladder cancer. Cholelithiasis has become a significant health problem in developed societies, affecting 10-15% of the adult population. Gallbladder polyps are incidentally detected in approximately 4-7% of patients. In addition, other gallbladder problems may also occur, but these are extremely rare: remnant cystic duct, gallbladder anomalies, Mirizzi syndrome, and gallbladder parasites. Endoscopic ultrasound (EUS) is an excellent method for visualizing the bile duct and gallbladder given its proximity when imaging from the duodenum. EUS can be used for evaluation of gallbladder disease that includes investigation of suspected cholelithiasis or biliary sludge, imaging of polypoid lesions of the gallbladder, and diagnosis and staging of gallbladder cancer. This procedure can be helpful to further distinguish benign from malignant or potentially malignant gallbladder polyps and play an important role in determining the treatment strategy for gallbladder polyps. Furthermore, EUS can help in the diagnosis of rarely gallbladder diseases such as remnant cystic duct, gallbladder anomalies, Mirizzi syndrome, and gallbladder parasites. Recent studies have suggested that EUS-guided gallbladder drainage (EUS-GBD) can be considered to be an effective emergency treatment for acute cholecystitis patients at high risk for surgery.

show abstract

Emerging Role of Endoscopic Ultrasound in the Diagnostic Evaluation of Idiopathic Pancreatitis

Cited by 30 publications

References 24 publications

Prospective Endoscopic Ultrasound-Based Approach to the Evaluation of Idiopathic Pancreatitis: Causes, Response to Therapy, and Long-term Outcome

Prospective Endoscopic Ultrasound-Based Approach to the Evaluation of Idiopathic Pancreatitis: Causes, Response to Therapy, and Long-term Outcome

Case of drug-induced acute pancreatitis produced by horsetail infusions

Endoscopic Ultrasonography (EUS) and Gallbladder

Contact Info

Product

Resources

About