Endoscopic Ultrasound and Magnetic Resonance Cholangiopancreatography in Patients with Idiopathic Acute Pancreatitis

Abstract

The combination of EUS and MRCP, when performed later after idiopathic acute pancreatitis, revealed 50 % of etiologies. The association of these two procedures and the subsequent follow-up reduced the rate of idiopathic pancreatitis by ~66 %.

Prospective evaluation of the aetiological profile of acute pancreatitis in young adult patients

“…We and others have previously described cases of cannabis-related AP, but their frequency could be underestimated for many reasons [5,[14][15][16][17][18][19]: (i) the cases of toxic-induced AP being often difficult to prove; (ii) the difficulty in monitoring cannabinoids in the body and determining its pathophysiology as a cause of AP; (iii) the illegality of cannabis use and, consequently, patients not admitting usage.…”

“…Other aetiologies (non-alcoholic, non-biliary AP) are less frequent; among these, the proportion of idiopathic AP has declined due to advances in radiological investigations and more detailed searches for autoimmune, drug-induced, or genetic causes [1][2][3][4][5].…”

Severe acute pancreatitis admitted to intensive care unit: SOFA is superior to Ranson’s criteria and APACHE II in determining prognosis

“…The most frequent etiological factors are alcohol consumption and biliary stones as well as post-endoscopic retrograde cholangiopancreatography (post-ERCP), surgery, certain drugs, HIV infection, hyperlipidemia, and biliary anomalies. It is regarded as idiopathic acute pancreatitis when no causative factor is determined (4).…”

Indications for ERCP

“…For instance, one study reported that the sensitivity of MRCP in the detection of choledocholithiasis decreases from 71 to 33 % as stone diameters fell below 6 mm [2]. Kondo et al corroborated this by stating that the performance of EUS was superior to loon dilation of the papilla performed, f followed by stone extraction using a biliary stone extraction balloon MRCP for detecting common bile duct stones < 5 mm in size [26,27]. There has been a debate whether the accuracy of MRCP for the detection of choledocholithiasis varies with ductal diameter.…”

“…This review demonstrated that EUS was more sensitive and accurate than cholangiography in the detection of stones smaller than 4 mm. The diagnostic limitation of cholangiography in detecting small stones was partly explained by loss of sensitivity in dilated ducts [26,28,29]. EUS offers very high-resolution images (0.1 mm), thus allowing the detection of very small diameter stones [6].…”