Researchers from the Digestive Disease Center at the Medical University of South Carolina, in Charleston, USA, have attempted to determine the diagnostic utility of various techniques in evaluating patients with unexplained pancreatitis.
Dr W.J. Coyle and colleagues assessed endoscopic retrograde cholangiopancreatography (ERCP) with sphincter of Oddi manometry (SOM), bile analysis and endoscopic ultrasound (EUS) in the diagnosis of such patients.
|31% of patients with unexplained pancreatitis had sphincter of Oddi dysfunction |
| Endoscopy |
Of 162 patients referred for evaluation of pancreatitis, 72 with a known cause were excluded from the study.
The remainder (n = 90) were classified as having prior acute (n = 24) or recurrent acute pancreatitis (n = 66).
Bile sampling and SOM were performed at the time of ERCP, while EUS was used to assess for tumors and chronic pancreatitis. Clinical outcomes were evaluated by questionnaire.
ERCP was successful in 88 out of 89 patients and manometry in 63 of 67 subjects. 56 patients underwent EUS.
Findings were categorized into 5 distinct etiologies: sphincter of Oddi dysfunction (SOD) (n = 28, 31%), pancreas divisum (n = 18, 20%), and tumor-related (n = 8, 9%).
Features of moderate or severe chronic pancreatitis by EUS and ERCP criteria were found in 18 patients (21%). 9 patients had pancreatitis by EUS criteria alone.
EUS identified all the tumors, and the condition was improved in 96% of all the patients undergoing endoscopic therapy.
The authors conclude that an etiology was identified in the majority of patients with unexplained pancreatitis, with SOD representing the most common finding.
They add that bile analysis, SOM, and EUS are useful tools in the evaluation of unexplained acute pancreatitis.