Does Endoscopic Ultrasonography Influence The Management Of Patients With Acute Pancreatitis?

Purpose: Endoscopic ultrasonography (EUS) is useful in detecting biliopancreatic diseases. This study is designed to evaluate the usefulness of EUS in detecting the cause of acute pancreatitis. Methods: In this study, we retrospectively analyzed 80 available cases, which were diagnosed as acute pancreatitis by computed tomography (CT) at our hospital between April 2000 and September 2007. Cases with obstructive pancreatitis due to pancreatic ductal carcinoma were excluded. Final diagnoses were determined by endoscopic retrograde cholangiopancreatography and/or surgical exploration, and all cases diagnosed as idiopathic were followed up at least 12 months after the initial diagnosis. As choledocholithiasis and occult intraductal pancreatic tumor (IPT) are thought as determinant factors for the management of acute pancreatitis, we evaluate the diagnostic accuracy of detecting these diseases in the following diagnostic processes. First, we tried to diagnose these factors only using CT in all cases. If choledocholithiasis were detected, we performed endoscopic treatment without performing EUS. Second, we performed EUS additionally for further examination, and reconsidered the management according to EUS findings. All cause was classified into 5 groups: choledocholithiasis including debris, alcoholic, spontaneous stones pass, IPT and idiopathic. Results: The number of each group was as follows: choledocholithiasis, 41; alcoholic, 21; spontaneous stones pass, 4; IPT, 3; idiopathic, 11. Only using CT, 16 of 41 cases with choledocholithiasis and 2 of 3 cases with IPT were missed. So 18 cases were incorrectly diagnosed in total, and the over all accuracy was 77.5% (62/80). EUS was additionally performed in 55 cases, and 16 cases with choledocholithiasis and 2 cases with IPT were correctly diagnosed. Therefore, additional EUS correctly influenced 16 of 16 misdiagnosed cases correctly. Neither another CT nor MRI could detect any abnormal findings in 2 cases with IPT (intraductal acinar cell carcinoma and non invasive minute ampullary carcinoma). Furthermore, findings of chronic pancreatitis (hyperechoic foci, hyperechoic strands, lobularity) were detected in 7 of 21 alcoholic cases. The over all accuracy of EUS was 100% (54/54), and was statistically higher than that of using only CT (p < 0.0005). Conclusions: EUS is very useful in detecting not only choledocholithiasis but also minute intraductal pancreatic tumor. We recommend EUS for all cases which are diagnosed as acute pancreatitis without choledocholithiasis by CT.