Endoscopic Ultrasound and Magnetic Resonance Cholangiopancreatography in Patients with Idiopathic Acute Pancreatitis
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ORIGINAL ARTICLE
Endoscopic Ultrasound and Magnetic Resonance Cholangiopancreatography in Patients with Idiopathic Acute Pancreatitis Aldine Thevenot • Barbara Bournet • Philippe Otal • Guillaume Canevet • Jacques Moreau • Louis Buscail
Received: 21 October 2012 / Accepted: 1 March 2013 / Published online: 19 March 2013 Ó Springer Science+Business Media New York 2013
Abstract Background The efficacy of endoscopic ultrasonography (EUS) to diagnose idiopathic acute pancreatitis has been demonstrated but that of magnetic-resonance cholangiopancreatography (MRCP) remains unclear. Aims The aim of our study was to prospectively compare the results of EUS and MRCP to diagnose idiopathic acute pancreatitis when performed later after an acute attack. Methods All patients admitted to our center for acute pancreatitis over a 2-year period received first-line investigations that included medical history, standard biological measurements, abdominal ultrasound, and computerized tomography. If no etiology was found, second-line investigations were scheduled at 2 months (or more if there was severe pancreatitis), which included clinical examinations, biological parameters, EUS, and MRCP. Results A total of 128 consecutive patients were included (male: 80, mean age: 55.3 years). After first-line investigations, 41 patients with idiopathic acute pancreatitis underwent second-line investigations and were followedup (38 patients had both EUS and MRCP). EUS and/or MRCP led to recognize a possible etiology of pancreatitis in 19 patients (50 %). The diagnostic yield for EUS was A. Thevenot J. Moreau Department of Gastroenterology, CHU Toulouse, University of Toulouse III, Toulouse, France B. Bournet L. Buscail (&) Department of Gastroenterology and INSERM U1037, CHU Toulouse Rangueil, University of Toulouse III, 1 avenue Jean Poulhe`s, TSA 50032, Toulouse Cedex 9, France e-mail: [email protected] P. Otal G. Canevet Department of Radiology, CHU Toulouse, University of Toulouse III, Toulouse, France
higher than for MRCP (29 vs. 10.5 %). EUS more accurately detected biliary stones whereas MRCP identified pancreatic duct abnormalities, such as intraductal papillary mucinous neoplasm of the pancreas or chronic pancreatitis. Conclusions The combination of EUS and MRCP, when performed later after idiopathic acute pancreatitis, revealed 50 % of etiologies. The association of these two procedures and the subsequent follow-up reduced the rate of idiopathic pancreatitis by *66 %. Keywords Intraductal papillary mucinous neoplasms of the pancreas Biliary microlithiasis Chronic pancreatitis Idiopathic acute pancreatitis Endoscopic ultrasonography Magnetic resonance cholangiopancreatography
Introduction Despite progress made in abdominal-imaging analysis, some patients suffering from acute pancreatitis (AP) still have no known etiology assessed from clinical, serological or imaging investigations performed at the initial phase of the disease. Depending on the series/study, 25–30 % of cases of AP are diagnosed as idiopathic be
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