Idiopathic Acute Pancreatitis (IAP): The Value of Endoscopic Ultrasound

Journal of Health and Medical Sciences

ISSN 2622-7258

Published: 25 June 2019

Idiopathic Acute Pancreatitis (IAP): The Value of Endoscopic Ultrasound

Bimal Chandra Shil, Madhusudan Saha, Md. Royes Uddin, ANM Saifullah, Imteaz Mahbub, Md. Mamun Ur-Rashid

Sir Salimullah Medical College, North East Medical College (Bangladesh)

pdf download

Download Full-Text Pdf

10.31014/aior.1994.02.02.41

Pages: 224-229

Keywords: Endoscopic Ultrasound, Idiopathic Acute Pancreatitis, Microlithiasis, Common Bile Duct Stone, Gall Bladder Stone.

Abstract

Introduction: Acute pancreatitis with unknown etiology comprises about 10-30% of all cases of acute pancreatitis. Endoscopic ultrasound is an important tool for revealing etiologies of the unknown causes of acute pancreatitis. The aim of this study was to evaluate the role of endoscopic ultrasound in sorting out the cause of idiopathic acute pancreatitis. Materials & Methods: It was a cross-sectional study which was carried out in the department of gastroenterology of Sir Salimullah medical college & Mitford hospital from January 2013 to December 2017. A total of 109 patients suffering from acute idiopathic pancreatitis were enrolled in this study. Underlying etiologies could not be detected after thorough history, physical examinations, blood tests, ultrasonography, CT, and/or MRI. These patients underwent endoscopic ultrasound under proper sedation after taking informed consent. Results: Among the 109 patients, 67 were male and 42 were female (P=0.03). Number of patients below 40yrs of age were 67 and above 40 years of age were 42 (P=0.01). Moreover, 81 patients had their gall bladder in situ and 28 had previous history of cholecystectomy (P=0.001). Microlithiasis 20 (24.6%), common bile duct stone or sludge 20 (24.6%), ampullary neoplasm 20 (24.67%), early stage of chronic pancreatitis 12 (14.8%), biliary ascariasis 08 (9.8%), small pancreatic head tumor 02 (2.5%) and pancreatic divisum 02 (2.5%) were found out as the underlying etiologies of idiopathic acute pancreatitis patients who had intact gall bladder. In patients who underwent cholecystectomy; endoscopic ultrasound revealed chronic pancreatitis 04 (14.3%), common bile duct stone or sludge 20 (24.6%), biliary ascariasis 06 (21.4%) and ampullary neoplasm 01 (3.5%) as the hidden causes of idiopathic acute pancreatitis. Conclusion: Gastroenterologists face difficulties to diagnose the actual etiology of idiopathic acute pancreatitis. As endoscopic ultrasound shows high efficacy and accuracy to detect etiologies in such cases; it can be included as a first line investigation in idiopathic acute pancreatitis.

References

  1. Ahad, M.A., 2016.Acute pancreatitis- a clinical update. Bangladesh Medical Journal Khulna, 50 (1-2), pp. 35-40.

  2. Ahmed, K.U., Ahad, M.A., Alim, M.A. and Ekram, A.S., 2016. Clinical profile of acute pancreatitis in a teaching hospital.Bangladesh Medical Journal Khulna, 49(1-2), pp.7-12.

  3. Al-Haddad, M. and Wallace, M.B., 2008. Diagnostic approach to patients with acute idiopathic and recurrent pancreatitis, what should be done? World journal of gastroenterology: WJG, 14(7), pp.1007-10.

  4.  Baillie, J., 2001. What should be done with idiopathic recurrent pancreatitis that remains ‘idiopathic’after standard investigation. JOP, 2(6), pp.401-405.

  5. Bradley, E.L., 1993. A clinically based classification system for acute pancreatitis: summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Archives of surgery, 128(5), pp.586-590.      

  6. Catalano, M.F., Lahoti, S., Geenen, J.E. and Hogan, W.J., 1998. Prospective evaluation of endoscopic ultrasonography, endoscopic retrograde pancreatography, and secretin test in the diagnosis of chronic pancreatitis. Gastrointestinal endoscopy, 48(1), pp.11-17.

  7. Choudhary, N.S., Bansal, R.K., Shah, V., Nasa, M., Puri, R., Thandassery, R., Singh, R.R., Bhasin, A., Bhatia, S., Misra, S.R. and Bhagat, S., 2016. Prospective evaluation of yield of endoscopic ultrasonography in the etiological diagnosis of" idiopathic" acute pancreatitis. Journal of Digestive Endoscopy, 7(4), p.133.

  8. Coyle, W.J., Pineau, B.C., Tarnasky, P.R., Knapple, W.L., Aabakken, L., Hoffman, B.J., Cunningham, J.T., Hawes, R.H. and Cotton, P.B., 2002. Evaluation of unexplained acute and acute recurrent pancreatitis using endoscopic retrograde cholangiopancreatography, sphincter of Oddi manometry and endoscopic ultrasound. Endoscopy, 34(08), pp.617-623.

  9. Dahan, P., Andant, C., Levy, P., Amouyal, P., Amouyal, G., Dumont, M., Erlinger, S., Sauvanet, A., Belghiti, J., Zins, M. and Vilgrain, V., 1996. Prospective evaluation of endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis in 45 patients with normal conventional ultrasonography. Gut, 38(2), pp.277-281.

  10. Dill, J.E. and Dill, B.P., 2002.Microlithiasis and pancreatitis. Gastroinestinal Endoscopy, 56(5), p.784

  11. Dill, J.E., Hill S., Callis, J., Berkhouse, L., Evans, P., Martin, D., and Palmer, S.T., 1995. Combined endoscopic ultrasound and stimulated biliary drainage in cholecystitis and microlithiasis, diagnosis and outcomes. Endoscopy, 27(6), pp.424-7

  12. Elzouki, A.N., Alsaed, O., Saeed, A., Ayash, A. and Khan, F.Y., 2019. Incidence and epidemiological features of acute pancreatitis among adult inhabitants in Qatar. Turkish Journal of Gastroenterology, 30(1), pp.95-100

  13. Frossard, J.L., Sosa-Valencia, L., Amouyal, G., Marty, O., Hadengue, A. and Amouyal, P., 2000. Usefulness of endoscopic ultrasonography in patients with “idiopathic” acute pancreatitis. The American journal of medicine, 109(3), pp.196-200.

  14. Frossard, J.L., Steer M.I. and Pastor C.M., 2008. Acute Pancreatitis. Lancet, 371, pp. 143-53.

  15. Gregor, J.C., Ponich, T.P. and Detsky, A.S., 1996. Should ERCP be routine after an episode of “idiopathic” pancreatitis? A cost-utility analysis. Gastrointestinal endoscopy, 44(2), pp.118-123.

  16. Hisanaga, K., Hisanaga, A., Nagata, K. and Ichie, Y., 1980. High speed rotating scanner for transgastric sonography. American Journal of Roentgenology, 135(3), pp.627-629.

  17. Irisawa, A., Katakura, K., Ohira, H., Sato, A., Bhutani, M.S., Hernandez, L.V. and Koizumi, M., 2007. Usefulness of endoscopic ultrasound to diagnose the severity of chronic pancreatitis. Journal of gastroenterology, 42(17), pp.90-94.

  18. Khuroo, M.S., Rather, A.A., Khuroo, N.S. and Khuroo, M.S., 2016. Hepatobiliary and pancreatic ascariasis. World journal of gastroenterology, 22(33), p.7507.

  19. Lee, S.P. and Nicholls, J.F., 1986. Nature and composition of biliary sludge. Gastroenterology, 90(3), pp.677-686.

  20. Lee, S.P., Nicholls, J.F. and Park, H.Z., 1992. Biliary sludge as a cause of acute pancreatitis. New England Journal of Medicine, 326(9), pp.589-593.

  21. Levy, M.J., 2002. The hunt for microlithiasis in idiopathic acute recurrent pancreatitis: should we abandon the search or intensify our efforts?. Gastrointestinal endoscopy, 55(2), pp.286-293.

  22. Levy, M.J. and Geenen, J.E., 2001. Idiopathic acute recurrent pancreatitis. The American journal of gastroenterology, 96(9), p.2540.

  23. Liu, C.L., Lo, C.M., Chan, J.K., Poon, R.T. and Fan, S.T., 2000. EUS for detection of occult cholelithiasis in patients with idiopathic pancreatitis. Gastrointestinal endoscopy, 51(1), pp.28-32.

  24. Neoptolemos, J.P., Davidson, B.R., Winder, A.F. and Vallance, D., 1988. Role of duodenal bile crystal analysis in the investigation of ‘idiopathic’pancreatitis. British journal of surgery, 75(5), pp.450-453.

  25. Ortega, A.R., Gómez-Rodríguez, R., Romero, M., Fernández-Zapardiel, S., del Mar Céspedes, M. and Carrobles, J.M., 2011. Prospective comparison of endoscopic ultrasonography and magnetic resonance cholangiopancreatography in the etiological diagnosis of" idiopathic" acute pancreatitis. Pancreas, 40(2), pp.289-294.

  26. Petrov, M.S. and Savides, T.J., 2009. Systematic review of endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis. British Journal of Surgery: Incorporating European Journal of Surgery and Swiss Surgery, 96(9), pp.967-974.

  27. Prat, F., Amouyal, G., Amouyal, P., Pelletier, G., Fritsch, J., Choury, A.D., Buffet, C. and Etienne, J.P., 1996. Prospective controlled study of endoscopic ultrasonography and endoscopic retrograde cholangiography in patients with suspected common-bileduct lithiasis. The Lancet, 347(8994), pp.75-79.

  28. Ros, E., Navarro, S., Bru, C., Garcia-Pugés, A. and Valderrama, R., 1991. Occult microlithiasis in ‘idiopathic’acute pancreatitis: prevention of relapses by cholecystectomy or ursodeoxycholic acid therapy. Gastroenterology, 101(6), pp.1701-1709.

  29. Sahai, A.V., Zimmerman, M., Aabakken, L., Tarnasky, P.R., Cunningham, J.T., van Velse, A., Hawes, R.H. and Hoffman, B.J., 1998. Prospective assessment of the ability of endoscopic ultrasound to diagnose, exclude, or establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography. Gastrointestinal endoscopy, 48(1), pp.18-25.

  30. Saleem, R., Raja, O., Aujla, U.I. and Devlin, J., 2015. OC-111 Diagnostic yield of endoscopic ultrasound (EUS) in the evaluation of idiopathic pancreatitis. a single tertiary referral Centre experience.

  31. Sivak, M.V. and Kaufman, A., 1986. Endoscopic ultrasonography in the differential diagnosis of pancreatic disease: a preliminary report. Scandinavian Journal of Gastroenterology, 21(sup123), pp.130-134.

  32. Somani, P. and Navaneethan, U., 2016. Role of ERCP in patients with idiopathic recurrent acute pancreatitis. Current treatment options in gastroenterology, 14(3), pp.327-339.

  33. Tandon, M. and Topazian, M., 2001. Endoscopic ultrasound in idiopathic acute pancreatitis. The American journal of gastroenterology, 96(3), p.705.

  34. Testoni, P.A., Mariani, A., Curioni, S., Zanello, A. and Masci, E., 2008. MRCP-secretin test–guided management of idiopathic recurrent pancreatitis: long-term outcomes. Gastrointestinal endoscopy, 67(7), pp.1028-1034.

  35. Vila, J.J., 2010. Endoscopic ultrasonography and idiopathic acute pancreatitis. World journal of gastrointestinal endoscopy, 2(4), p.107.     

  36. Vila, J.J., Vicuña, M., Irisarri, R., Gonzalez de la Higuera, B., Ruiz-Clavijo, D., Rodríguez-Gutiérrez, C., Urman, J.M., Bolado, F., Jiménez, F.J. and Arín, A., 2010. Diagnostic yield and reliability of endoscopic ultrasonography in patients with idiopathic acute pancreatitis. Scandinavian journal of gastroenterology, 45(3), pp.375-381.

  37. Wilcox, C.M. and Kilgore, M., 2009. Cost minimization analysis comparing diagnostic strategies in unexplained pancreatitis. Pancreas, 38(2), pp.117-121.

  38. Yusoff, I.F., Raymond, G. and Sahai, A.V., 2004. A prospective comparison of the yield of EUS in primary vs. recurrent idiopathic acute pancreatitis. Gastrointestinal endoscopy, 60(5), pp.673-678.

About Us

The Asian Institute of Research is an online and open-access platform to publish recent research and articles of scholars worldwide. Founded in 2018 and based in Indonesia, the Institute serves as a platform for academics, educators, scholars, and students from Asia and around the world, to connect with one another. The Institute disseminates research that is proven or predicted to be of significant influence for the general public.

Contact Us

Please send all inquiries to the email:

editorial@asianinstituteofresearch.org

Business Address:

5th Floor, Kavling 507, Fajar Graha Pena Tower, Jl. Urip Sumohardjo No.20, Makassar, Indonesia 90234

Copyright © 2018 The Asian Institute of Research. All rights reserved

Stay Connected

  • Instagram - Black Circle
  • Facebook - Black Circle
  • LinkedIn - Black Circle