ROLE OF EARLY ENDOSCOPIC ULTRASOUND IN IDIOPATHIC ACUTE PANCREATITIS

Aims:

The cause of acute pancreatitis (AP) remains elusive even after extensive work up in 10 – 30% of cases. The aim of our study was to evaluate the diagnostic yield, feasibility, and management changes of early EUS, performed within 24 – 48 hours of admission in patients with idiopathic acute pancreatitis (IAP).

Methods:

During the study period (2010 – 2016), 850 cases of AP were admitted. Out of these, aetiology was determined in 666 (78.35%). There were 184 cases of IAP. EUS was done using linear/radial echo endoscope.

Results:

Out of 158 cases (90 males; age range: 15 – 70 years) of IAP, (26 were excluded), EUS was able to clinch the diagnosis in 110 patients (69.6%). The most common causes of IAP included biliary stone disease (gallbladder microlithiaisis, common bile duct microlithiasis/stone/sludge) (n = 60) followed by chronic pancreatitis (CP) (n = 25), pancreatic tumour (n = 11) and pancreaticobiliary ascariasis (n = 10). Other etiologies included hydatid cyst rupture of bile duct, opium addiction and duplication cyst. No cause was found in 48 (31.4%) patients.

Conclusions:

Early EUS establishes diagnosis in about 70% cases of IAP and changes the short term management in IAP. Biliary stone disease was the predominant cause for IAP followed by CP. EUS is a safe investigation with a high diagnostic yield. An early EUS can influence important therapeutic decisions and prevent further attacks of AP which may occur if a delayed EUS is performed and thus improve long term prognosis. An early EUS has an additional advantage of making an early diagnosis of pancreatic tumours/pancreaticobiliary ascariasis and ampullary/papillary stones which can be treated endoscopically. It also prevents making the wrong diagnosis of sludge as etiological factor for AP which may occur in patients undergoing a delayed EUS since sludge may be secondary to AP due to prolonged fasting, total parenteral nutrition or antibiotics like ceftriaxone.