Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(10): E1441-E1447
DOI: 10.1055/a-1233-1849
Original article

EUS is superior to secretin-enhanced cholangio-MRI to establish the etiology of idiopathic acute pancreatitis

Juan J. Vila
1   Endoscopy Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
,
F. Javier Jiménez Mendioroz
2   Digestive Radiology Unit, Radiology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
,
Paul Yeaton
3   Endoscopy Unit, Gastroenterology Department, Carilion Clinic, Roanoke, Virginia, United States
,
Iñaki Fernández-Urién
1   Endoscopy Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
,
José Luis García Sanchotena
2   Digestive Radiology Unit, Radiology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
,
Silvia Goñi
1   Endoscopy Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
,
Marta Gómez Alonso
1   Endoscopy Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
,
Juan Carrascosa
1   Endoscopy Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
,
Ana Borda
1   Endoscopy Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
,
Carlos Prieto
4   Biliary and Pancreatic Diseases Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
,
Jesús Urman
4   Biliary and Pancreatic Diseases Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
,
José M Zozaya
1   Endoscopy Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
4   Biliary and Pancreatic Diseases Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims The etiology of idiopathic acute pancreatitis (IAP) should always be defined. Our aim was to compare the diagnostic value of endoscopic ultrasound (EUS) versus secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) in patients with IAP.

Patients and Methods Patients admitted to a single tertiary care University hospital with IAP were invited to participate in the study. Enrolled patients underwent EUS and S-MRCP in a single-blinded comparative study. EUS and S-MRCP were performed no sooner than 4 weeks after discharge. The diagnostic yield of EUS and S-MRCP and demographic variables were included in the analysis. Additional follow-up, results of subsequent serology, radiographic exams, and relevant histological analysis were considered in determination of the final diagnosis.

Results A total of 34 patients were enrolled; EUS was normal in six, cholelithiasis was defined in 15, choledocholithiasis in two, pancreas divisum in three, branch-type intraductal papillary mucinous tumor (IPMT) in three, and chronic pancreatitis in five. S-MRCP identified choledocholithiasis in one, divisum in four, branch-type IPMT in three, chronic pancreatitis in two; 24 subjects diagnosed as normal by S-MRCP. Diagnostic correlation between EUS and S-MRCP was slight (kappa = 0.236, 95 % confidence interval: 0.055–0.416). EUS provided a statistically significantly higher diagnostic yield than S-MRCP: 79.4 % (CI95 %: 65 %–94 %) vs 29.4 % (CI95 %: 13 %–46 %) (P = 0.0002). The sensitivity, specificity, and positive and negative predictive values of EUS and S-MRCP were 90 %, 80 %, 96 %, 57 % and 33 %, 100 %, 100 % and 16 %, respectively.

Conclusion The diagnostic yield of EUS is higher than S-MRCP in patients with IAP.



Publication History

Received: 29 November 2019

Accepted: 08 July 2020

Article published online:
07 October 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Steinberg W, Tenner S. Acute pancreatitis. N Engl J Med 1994; 330: 1198-1210
    CrossrefPubMedGoogle Scholar
  • 2 Lee SP, Nicholls JF, Park HZ. Biliary sludge as a cause of acute pancreatitis. N Engl J Med 1992; 326: 589-593
    CrossrefPubMedGoogle Scholar
  • 3 Vila JJ. Endoscopic ultrasonography and idiopathic acute pancreatitis. World J Gastrointest Endosc 2010; 2: 107-111
    CrossrefPubMedGoogle Scholar
  • 4 Bank S, Indaram A. Causes of acute and recurrent pancreatitis. Clinical considerations and clues to diagnosis. Gastroenterol Clin North Am 1999; 28: 571-589 , viii
    CrossrefPubMedGoogle Scholar
  • 5 Kohut M, Nowak A, Nowakowska-Duława E. et al. The frequency of bile duct crystals in patients with presumed biliary pancreatitis. Gastrointest Endosc 2001; 54: 37-41
    CrossrefPubMedGoogle Scholar
  • 6 Mallery JS, Baron TH, Dominitz JA. et al. Complications of ERCP. Gastrointest Endosc 2003; 57: 633-638
    CrossrefPubMedGoogle Scholar
  • 7 Coyle WJ, Pineau BC, Tarnasky PR. et al. Evaluation of unexplained acute and acute recurrent pancreatitis using endoscopic retrograde cholangiopancreatography, sphincter of Oddi manometry and endoscopic ultrasound. Endoscopy 2002; 34: 617-623
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Moskovitz M, Min TC, Gavaler JS. The microscopic examination of bile in patients with biliary pain and negative imaging tests. Am J Gastroenterol 1986; 81: 329-333
    PubMedGoogle Scholar
  • 9 Reyes López A, Miño Fugarolas G, Costán Rodero G. et al. Value of duodenal drainage in the etiologic diagnosis of acute pancreatitis. Rev Esp Enferm Dig 1993; 83: 363-366
    PubMedGoogle Scholar
  • 10 Govil A, Agrawal MK, Agrawal D. et al. Role of endoscopic ultrasonography in patients with first episode of idiopathic acute pancreatitis. Indian J Gastroenterol 2014; 33: 241-248
    CrossrefPubMedGoogle Scholar
  • 11 Morris-Stiff G, Al-Allak A, Frost B. et al. Does endoscopic ultrasound have anything to offer in the diagnosis of idiopathic acute pancreatitis?. JOP 2009; 10: 143-146
    PubMedGoogle Scholar
  • 12 Vila JJ, Vicuña M, Irisarri R. et al. Diagnostic yield and reliability of endoscopic ultrasonography in patients with idiopathic acute pancreatitis. Scand J Gastroenterol 2010; 45: 375-381
    CrossrefPubMedGoogle Scholar
  • 13 Ardengh JC, Malheiros CA, Rahal F. et al. Microlithiasis of the gallbladder: role of endoscopic ultrasonography in patients with idiopathic acute pancreatitis. Rev Assoc Med Bras 2010; 56: 27-31
    CrossrefPubMedGoogle Scholar
  • 14 Rana SS, Bhasin DK, Rao C. et al. Role of endoscopic ultrasound in idiopathic acute pancreatitis with negative ultrasound, computed tomography, and magnetic resonance cholangiopancreatography. Ann Gastroenterol 2012; 25: 133-137
    PubMedGoogle Scholar
  • 15 Khalid A, Peterson M, Slivka A. Secretin-stimulated magnetic resonance pancreaticogram to assess pancreatic duct outflow obstruction in evaluation of idiopathic acute recurrent pancreatitis: a pilot study. Dig Dis Sci 2003; 48: 1475-1481
    CrossrefPubMedGoogle Scholar
  • 16 Testoni PA, Mariani A, Curioni S. et al. MRCP-secretin test-guided management of idiopathic recurrent pancreatitis: long-term outcomes. Gastrointest Endosc 2008; 67: 1028-1034
    CrossrefPubMedGoogle Scholar
  • 17 Mariani A, Arcidiacono PG, Curioni S. et al. Diagnostic yield of ERCP and secretin-enhanced MRCP and EUS in patients with acute recurrent pancreatitis of unknown aetiology. Dig Liver Dis 2009; 41: 753-758
    CrossrefPubMedGoogle Scholar
  • 18 Ortega AR, Gómez-Rodríguez R, Romero M. et al. Prospective comparison of endoscopic ultrasonography and magnetic resonance cholangiopancreatography in the etiological diagnosis of “idiopathic” acute pancreatitis. Pancreas 2011; 40: 289-294
    CrossrefPubMedGoogle Scholar
  • 19 Thevenot A, Bournet B, Otal P. et al. Endoscopic ultrasound and magnetic resonance cholangiopancreatography in patients with idiopathic acute pancreatitis. Dig Dis Sci 2013; 58: 2361-2368
    CrossrefPubMedGoogle Scholar
  • 20 Sahai AV, Zimmerman M, Aabakken L. et al. Prospec- tive assessment of the ability of endoscopic ultrasound to diagnose, exclude, or establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography. Gastrointest Endosc 1998; 48: 18-25
    CrossrefPubMedGoogle Scholar
  • 21 Axon AT, Classen M, Cotton PB. et al. Pancreatography in chronic pancreatitis: international definitions. Gut 1984; 25: 1107-1112
    CrossrefPubMedGoogle Scholar
  • 22 Lee SP, Maher K, Nicholls JF. Origin and fate of biliary sludge. Gastroenterology 1988; 94: 170-176
    CrossrefPubMedGoogle Scholar
  • 23 Janowitz P, Kratzer W, Zemmler T. et al. Gallbladder sludge: spontaneous course and incidence of complications in patients without stones. Hepatology 1994; 20: 291-294
    CrossrefPubMedGoogle Scholar
  • 24 Ros E, Navarro S, Bru C. et al. Occult microlithiasis in ‘idiopathic’ acute pancreatitis: prevention of relapses by cholecystectomy or ursodeoxycholic acid therapy. Gastroenterology 1991; 101: 1701-1709
    CrossrefPubMedGoogle Scholar
  • 25 Dahan P, Andant C, Lévy P. et al. Prospective evaluation of endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis in 45 patients with normal conventional ultrasonography. Gut 1996; 38: 277-281
    CrossrefPubMedGoogle Scholar
  • 26 Vila JJ, Arín A, Borobio E. et al. Prospective double blinded comparison of endosonography versus microscopic bile examination for diagnosing microlithiasis in patients with biliary colic or idiopathic acute pancreatitis [Abstract]. Endoscopy 2007; 39: A281
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Saraswat VA, Sharma BC, Agarwal DK. et al. Biliary microlithiasis in patients with idiopathic acute pancreatitis and unexplained biliary pain: response to therapy. J Gastroenterol Hepatol 2004; 19: 1206-1211
    CrossrefPubMedGoogle Scholar
  • 28 Ko CW, Schulte SJ, Lee SP. Biliary sludge is formed by modification of hepatic bile by the gallbladder mucosa. Clin Gastroenterol Hepatol 2005; 3: 672-678
    CrossrefPubMedGoogle Scholar
  • 29 Wallace MB, Hawes RH, Durkalski V. et al. The reliability of EUS for the diagnosis of chronic pancreatitis: interobserver agreement among experienced endosonographers. Gastrointest Endosc 2001; 53: 294-299
    CrossrefPubMedGoogle Scholar