The role of endoscopic ultrasound in patients with acute pancreatitis

OBJECTIVES: Acute biliary pancreatitis is the most common form of acute pancreatitis worldwide. Endoscopic ultrasound (EUS) may be helpful in detecting common bile duct stones and in indicating more invasive endoscopic retrograde cholangiopancreatography (ERCP) examinations or determining rarer aetiologies of acute pancreatitis. METHODS: Over a period of six years, we prospectively collected 131 patients with acute biliary pancreatitis and observed the need for endoscopic examination alongside with a decrease in the number of necessary ERCP examinations as a result of negative EUS results (no bile duct stones detected). We compared groups of patients given different endoscopic treatments in relation to their hospital mortality relative to the incidence of severe acute pancreatitis. RESULTS: As many as 68 % of primarily indicated EUS examinations had a negative result (no common bile duct stones detected) and this result saved the patients from needing to undergo an invasive ERCP procedure. Both the incidence of the severe form of acute pancreatitis and the hospital mortality rate were lower among patients who underwent only EUS or ERCP after EUS as compared to patients who underwent ERCP straight away. CONCLUSION: The use of EUS in patients with acute pancreatitis is very helpful in determining the treatment strategy (ERCP indication) and may reduce hospital mortality (Tab. 2, Ref. 14).