Imaging tests for accurate diagnosis of acute biliary pancreatitis

Abstract

Gallstones represent the most frequent aetiology of acute pancreatitis in many statistics all over the world, estimated between 40%-60%. Accurate diagnosis of acute biliary pancreatitis (ABP) is of outmost importance because clearance of lithiasis [gallbladder and common bile duct (CBD)] rules out recurrences. Confirmation of biliary lithiasis is done by imaging. The sensitivity of the ultrasonography (US) in the detection of gallstones is over 95% in uncomplicated cases, but in ABP, sensitivity for gallstone detection is lower, being less than 80% due to the ileus and bowel distension. Sensitivity of transabdominal ultrasonography (TUS) for choledocolithiasis varies between 50%-80%, but the specificity is high, reaching 95%. Diameter of the bile duct may be orientative for diagnosis. Endoscopic ultrasonography (EUS) seems to be a more effective tool to diagnose ABP rather than endoscopic retrograde cholangiopancreatography (ERCP), which should be performed only for therapeutic purposes. As the sensitivity and specificity of computerized tomography are lower as compared to state-of-the-art magnetic resonance cholangiopancreatography (MRCP) or EUS, especially for small stones and small diameter of CBD, the later techniques are nowadays preferred for the evaluation of ABP patients. ERCP has the highest accuracy for the diagnosis of choledocholithiasis and is used as a reference standard in many studies, especially after sphincterotomy and balloon extraction of CBD stones. Laparoscopic ultrasonography is a useful tool for the intraoperative diagnosis of choledocholithiasis. Routine exploration of the CBD in cases of patients scheduled for cholecystectomy after an attack of ABP was not proven useful. A significant rate of the so-called idiopathic pancreatitis is actually caused by microlithiasis and/or biliary sludge. In conclusion, the general algorithm for CBD stone detection starts with anamnesis, serum biochemistry and then TUS, followed by EUS or MRCP. In the end, bile duct microscopic analysis may be performed by bile harvested during ERCP in case of recurrent attacks of ABP and these should be followed by laparoscopic cholecystectomy.

Ultrasonic Pressure Ballistic System-Assisted Minimally Invasive Pancreatic Necrosectomy for Necrotizing Pancreatitis

“…Unlike in western countries, in our country, pancreatitis is often caused by acute biliary disorders. 29,30 Importantly, biliary obstructions can lead to critical outcomes. However, due to the poor condition of patients, endoscopic retrograde cholangiopancreatography (ERCP) is the preferred treatment.…”

The Usefulness of Early Endoscopic Ultrasonography in Acute Biliary Pancreatitis with Undetectable Choledocholithiasis on Multidetector Computed Tomography

“…These results are consistent with those of other studies that reported the suspected biliary origin of ABP in cases of jaundice, elevated ALT (three times greater than normal), or dilated CBD. 29,30 The present study has several limitations. First, the retrospective and cross-sectional nature of the study limited the number of patients with ABP who underwent EUS and whose BDS were undetectable on MDCT.…”

Validez diagnóstica de la endosonografía biliopancreática en el diagnóstico de colangitis aguda secundaria a obstrucción biliar

“…Igualmente, ha mostrado su valor en detección de cán-cer pancreático con una sensibilidad del 93% al 100%, de tumores del conducto biliar con una sensibilidad del 80% (12, 13) y de estenosis biliares benignas (14,16,17).…”