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 22 May 2018

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EUS yield in primary vs recurrent idiopathic acute pancreatitis

In patients with idiopathic pancreatitis, the yield of EUS is not significantly different after an initial attack or after recurrent attacks, hence it is reasonable to perform EUS after an initial attack especially in older patients, reports a study in November's Gastrointestinal Endoscopy.

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It is uncertain whether EUS should be performed after a single episode of idiopathic pancreatitis vs. recurrent episodes or if clinical factors can predict positive EUS findings.

Dr Ian Yusoff and researchers from Quebec in Canada studied consecutive patients with a single episode of idiopathic pancreatitis or with recurrent episodes underwent EUS (with analysis of bile for bilirubinate and cholesterol crystals, when possible).

The researchers compared the diagnostic yield for patients with a single episode of idiopathic pancreatitis and recurrent episodes (stratified by cholecystectomy status).

The research team sought to identify predictors of positive EUS findings.

EUS was considered “positive” if it identified any possible cause of pancreatitis other than chronic pancreatitis.

The researchers studied a total of 370 patients.

Of these, 246 were in the 'no-cholecystectomy group' with 134 of these participants having had a single episode of idiopathic pancreatitis and 112 having had recurrent episodes.

The research group included 124/370 participants in the post-cholecystectomy group [67 single episode of idiopathic pancreatitis, 57 recurrent episodes].

Positive EUS findings:
Single episode of idiopathic pancreatitis 31.3%
Recurrent episodes 32.1%
Gastrointestinal Endoscopy

Overall, the researchers noted that EUS yielded a positive finding in 29.2%.

The researchers found that for patients in the no-cholecystectomy group, positive EUS findings were not significantly more frequent in those with a single episode of idiopathic pancreatitis vs. those with recurrent episodes (31.3% vs. 32.1%).

In the post-cholecystectomy group, the yield was not significantly different for single episode of idiopathic pancreatitis (29.9%) vs. recurrent episodes (17.5%).

The research team observed that chronic pancreatitis was the only abnormality identified in 30.9% of patients in the no-cholecystectomy group vs. 26.6% of those in the post-cholecystectomy group.

It was the most common abnormality found in all 4 subgroups (range 16.4%-42.0%) and was approximately twice as frequent in patients with recurrent episodes vs. a single episode of idiopathic pancreatitis (no-cholecystectomy: 42.0% vs. 21.6%; post-cholecystectomy: 38.6% vs. 16.4%.

The researchers analyzed bile and revealed crystals in 38/80 (47.5%) patients in whom it could be performed.

The researchers found that patients with positive EUS findings tended to be older.

Dr Yusoff concluded, "In patients with idiopathic pancreatitis, the yield of EUS is not significantly different after an initial attack or after recurrent attacks."

"Therefore, it is reasonable to perform EUS after an initial attack of idiopathic acute pancreatitis, especially in older patients."

Gastrointestinal Endoscopy; 2004: 60 (5): page 673
25 November 2004

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