Utility of endoscopic ultrasound in idiopathic acute recurrent pancreatitis

Abstract

Idiopathic acute recurrent pancreatitis (IARP) is defined as at least two episodes of acute pancreatitis with the complete or near-complete resolution of symptoms and signs of pancreatitis between episodes, without an identified cause. There is a paucity of information about the usefulness of endoscopic ultrasound (EUS) in IARP.ObjectivesTo determine the diagnostic yield of EUS in IARP.DesignA retrospective study was performed in patients with IARP evaluated by EUS between January 2009 and December 2016. Follow-up assessments of acute pancreatitis recurrence were carried out.ResultsSeventy-three patients with 102 EUS procedures were included. EUS was able to identify the cause of IARP in 55 patients (75.3%). The most common findings were chronic pancreatitis in 27 patients (49.1%), followed by lithiasic pathology in 24 patients (43.6%), and intraductal papillary mucinous neoplasm in four patients (7.3%). A directed treatment against EUS findings had a protective tendency associated with the final resolution of recurrence. There were no complications reported.ConclusionEUS performed in patients with IARP helped to identify a possible cause in 2/3 of the cases. The majority of patients have a treatable disease.

Evolution of Rosemont’s indeterminate for chronic pancreatitis in recurrent acute pancreatitis patients with 1-year follow-up: A prospective case series

“…Majority patients presented after or during fourth episode of AP, also observed in study by Tepox-Padrón et al, 13 In contrast, majority patients in study by Sajith et al, 9 presented during third episode and in European and Chinese studies [10][11][12] during second episode. Mean duration between first AP episode and EUS examination was 39 months.…”

Endoscopic Ultrasound to Identify the Actual Cause of Idiopathic Acute Pancreatitis: A Systematic Review

“…EUS offers direct visualization of the pancreatic duct system with a high sensitivity, similar to MRCP [36]. In cases where pancreas divisum is associated with pancreatitis, the literature suggests that ERCP with minor papilla sphincterotomy and dorsal duct (Santorini) stent placement can effectively serve as preventive measures against future episodes and may provide relief from symptoms [34,[53][54][55][56]. As a treatment tailored according to the aetiology is associated with a reduction of recurrence, an EUS-based management strategy is suggested in patients with IARP [54].…”

Pancreatitis aguda recurrente: abordaje y tratamiento endoscópico

“…El ultrasonido endoscópico (USE) es la herramienta endoscópica que ha demostrado mayor utilidad en PAR. Estudios recientes realizados en nuestro medio han mostrado que el USE permite identificar la causa en 2/3 partes de los pacientes con PAR 12 .…”