Usefullness of Endoscopic Ultrasound (EUS) in early biliary pancreatitis without cholestasis on conventional imaging

AIM to assess the outcome of acute biliary pancreatitis (ABP) using EUS for deciding to perform an ERCP.

METHODS Our retrospective study included ABP patients without cholangitis or cholestasis on imaging admitted in our Department between 07/2017-10/2019. Biliary etiology of pancreatitis was defined as presence of gallstones/sludge on imaging or history of cholecystectomy with elevated liver enzymes(ALT,AST and/or alkaline phosphatase  > 2xULN). ABP patients were first evaluated by EUS and if choledocholithiasis was diagnosed ERCP was subsequently performed.

RESULTS Our study included 49 ABP patients with a mean age of 64.6 ± 19.4years.Obesity was present in 34.6 % of cases.Gallbladder stones were diagnosed in 77.5 % of patients and 22.5 % undergo previously cholecystectomy. Ranson score at admission ≥ 3 was present in 20.4 % of patients, C reactive protein  > 150 mg/dl at admission in 16.3 % . Choledocholithiasis was diagnosed in 18/49(36.7 %) by EUS. ERCP could be successfully performed in 15/18(83.3 %) of patients. We did not have ABP related mortality in our study cohort.Development of severe pancreatitis,organ failure, cholangitis, readmission because of biliary complications and hospital stay were similar in patients with ruled-outcholedocholithiasis in EUS(and no ERCP) and these with positive EUS and consequently performed ERCP with successfully removal of biliary tract stones(Table). Two from three patients(66.6 %) with choledocholithiasis by EUS and unsuccessfully ERCP developed severe pancreatitis with persistent organ failure and need of intensive care admission.

CONCLUSION EUS is a very good method for diagnosing choledocholithiasis in ABP patients without obvious cholestasis and helps to decide if ERCP is needed.

Tab. 1

	Positive EUS and successufully ERCP (n = 15)	Negative EUS, no ERCP (n = 31)	p
Severity -mild -moderately severe -severe	93.3 % 6.7 % 0 %	90.3 % 9.7 % 0 %	0.81 0.82 -
Organ failure/ICU admissionCholangitis/Pancreatic necrosis	0 %/0 %6.6 %/6.6 %	0 %/0 %0 %/6.4 %	-/-0.71/0.53
Readmission (biliary complications) Hospital stay	6.6 % 7 ± 1.3	3.2 % 6.5 ± 1.3	0.80 0.97

Publication History

Article published online:
26 May 2020