ROLE OF ENDOSCOPIC ULTRASOUND IN IDIOPATHIC ACUTE PANCREATITIS

Aims Acute pancreatitis has no obvious cause after clinical, laboratory and radiologic investigation in 10%-30% of patients.

Endoscopic ultrasound is promising and is particularly effective in the exploration of the bilio-pancreatic region.

Methods This is a descriptive retrospective study, including 58 patients between January 2008 and September 2019. The epidemiological data of the patients and the etiology of acute pancreatitis were evaluated. The examination was performed using a radial endoscopic ultrasound in all cases. Data collection and statistical analysis were performed by the SPSS22.0 software.

Results 482 patients underwent high endoscopic ultrasound during the study period, of whom 58 had unexplained acute pancreatitis(12%).

The average age of our patients was 55.7±16.95 years with extremes ranging from 18 to 89 years. The sex ratio (H/F) was 0.8 with a slight female predominance.

Endoscopic ultrasonography was performed transbulbally in 63.8% of cases (n=37), transgastric in 3.4%(n=2) and combined in 32.8% of cases (n=19).

15.5% of patients had a history of cholecystectomy (n=9). Gall bladder was lithiasic in 29.3% of cases (n=17). Main bile duct was normal in 66.1% of cases (n=37) and dilated in 10.3%(n=6). Wirsung was fine in 86% of cases (n=49).

The diagnosis was retained in 37.9% of patients (n=22). Biliary origin was identified in 17.2%(n=10) of patients; of which 7 benefited from a complementary ERCP at the same time anesthetic. A tumor cause was found in 6.9% of cases (n=4). Chronic pancreatitis was detected in 13.8% of cases (n=8).

Otherwise, no obvious cause was found in 62.1% of patients(n=36).

Conclusions Endoscopic ultrasound is a very sensitive imaging modality for the detection of the etiologies of acute pancreatitis. Biliary stones and chronic pancreatitis are the most important etiologies in our study.