• Acute pancreatitis
• Elderly
• India
• Mortality
• Outcomes

• acute pancreatitis
• cannabis
• kidney transplantation
• sirolimus
• tacrolimus

• Humans
• Pancreatitis/therapy
• Pancreatitis/etiology
• Pancreatitis/diagnosis
• Acute Disease
• Cholangiopancreatography, Endoscopic Retrograde
• United States

• acute pancreatitis
• bile duct stones
• biliary pancreatitis
• echoendoscopy
• endoscopic ultrasound
• endosonography
• idiopathic acute pancreatitis
• microlithiasis

• annular pancreas
• endosonography
• magnetic resonance cholangiopancreatography
• pancreas divisum

• Acute pancreatitis
• autoimmune pancreatitis
• chronic pancreatitis
• endosonography
• magnetic resonance imaging
• pancreatic necrosis
• transmural drainage

Background: Patients with acute idiopathic pancreatitis (AIP) should undergo further imaging tests such as endoscopic ultrasound (EUS) for further investigation. The time interval between an episode of AIP and EUS performance is still controversial. Aims: We aimed to explore the optimal timing for performing EUS and to reveal parameters that might predict longer intervals needed for performing EUS. Methods: We performed a single-center retrospective study at Galilee Medical Center from January 2015 to January 2020, at which point we included all patients who underwent EUS for further investigation of AIP. Results: Overall, we included 50 patients. The average age of all patients was 54.2 ± 17.6 years (range 22–69 years), and more than half of the study cohort were males (58%). Classifying patients as inflamed vs. normal pancreatic tissue on EUS, we found that among patients with normal pancreatic tissue, EUS was performed 44.7 ± 28.3 days from discharge, while for patients with inflamed pancreatic tissue, it was 48.1 ± 22.3 days (p = 0.37) after discharge. Notably, the CT severity index was significantly associated with inflamed pancreatic tissue on EUS, as it was 2.4 ± 0.74 vs. 1.5 ± 1.3 in the normal pancreatic tissue group (p = 0.03). There were no differences in the Bedside index for severity in acute pancreatitis (BISAP) scores, and there were no differences in the average American Society of Anesthesiologist Physical Status (ASA) scores between the two groups. Notably, 26.3% of patients had inflamed pancreatic tissue when performing EUS at 4 weeks, as compared to 16% who had inflamed pancreatic tissue at EUS performed after 6 weeks. Conclusion: Radiological severity score was the only important factor in determining the time interval of performing EUS after an episode of AIP. Intervals greater than six weeks seem to be needed among patients with higher Balthazar scores.

• Animals
• Endosonography
• Equipment Design
• Macaca mulatta
• Phantoms, Imaging
• Transducers
• Ultrasonography

• Biliary sludge
• Chronic pancreatitis
• Endoscopic retrograde cholangiopancreatography
• Endoscopic ultrasonography
• Gallstone
• Magnetic resonance cholangiopancreatography
• Microlithiasis
• Pancreas divisum
• Pancreatitis

• Adult
• Biliary Tract Diseases/complications
• Biliary Tract Diseases/diagnostic imaging
• Cholangiopancreatography, Magnetic Resonance/methods
• Diagnosis, Differential
• Endosonography/methods
• Female
• Humans
• Male
• Middle Aged
• Multimodal Imaging
• Pancreas/diagnostic imaging
• Pancreatic Diseases/complications
• Pancreatic Diseases/diagnostic imaging
• Pancreatitis/diagnosis
• Pancreatitis/etiology
• Prospective Studies
• Reproducibility of Results

Idiopathic acute recurrent pancreatitis (IARP) is defined as at least two episodes of acute pancreatitis with the complete or near-complete resolution of symptoms and signs of pancreatitis between episodes, without an identified cause. There is a paucity of information about the usefulness of endoscopic ultrasound (EUS) in IARP.

• acute pancreatitis
• biliary endoscopy
• endoscopic ultrasonography

• Acute pancreatitis
• Endoscopic ultrasound
• Idiopathic pancreatitis

• Acute Disease
• Algorithms
• Female
• Humans
• Male
• Middle Aged
• Pancreatitis/blood
• Pancreatitis/diagnosis
• Pancreatitis/etiology
• Recurrence
• Risk Factors

• Animals
• Cysts/diagnostic imaging
• Equipment Design
• Intestines/diagnostic imaging
• Metals, Heavy/chemistry
• Models, Biological
• Phantoms, Imaging
• Swine
• Transducers
• Ultrasonography, Interventional/instrumentation
• Ultrasonography, Interventional/methods

• endoscopy
• hepatobiliary disease
• pancreatic disease

• Acute Disease
• Endosonography
• Humans
• Multicenter Studies as Topic
• Netherlands
• Pancreatitis/diagnostic imaging
• Prospective Studies
• Quality of Life

Occult biliary disease has been suggested as a frequent underlying cause of idiopathic acute pancreatitis (IAP). Cholecystectomy has been proposed as a strategy to prevent recurrent IAP. The aim of this systematic review was to determine the efficacy of cholecystectomy in reducing the risk of recurrent IAP.

PubMed, Embase and Cochrane Library databases were searched systematically for studies including patients with IAP treated by cholecystectomy, with data on recurrence of pancreatitis. Studies published before 1980 or including chronic pancreatitis and case reports were excluded. The primary outcome was recurrence rate. Quality was assessed using the Newcastle–Ottawa Scale. Meta‐analyses were undertaken to calculate risk ratios using a random‐effects model with the inverse‐variance method.

Overall, ten studies were included, of which nine were used in pooled analyses. The study population consisted of 524 patients with 126 cholecystectomies. Of these 524 patients, 154 (29·4 (95 per cent c.i. 25·5 to 33·3) per cent) had recurrent disease. The recurrence rate was significantly lower after cholecystectomy than after conservative management (14 of 126 (11·1 per cent) versus 140 of 398 (35·2 per cent); risk ratio 0·44, 95 per cent c.i. 0·27 to 0·71). Even in patients in whom IAP was diagnosed after more extensive diagnostic testing, including endoscopic ultrasonography or magnetic resonance cholangiopancreatography, the recurrence rate appeared to be lower after cholecystectomy (4 of 36 (11 per cent) versus 42 of 108 (38·9 per cent); risk ratio 0·41, 0·16 to 1·07).

Cholecystectomy after an episode of IAP reduces the risk of recurrent pancreatitis. This implies that current diagnostics are insufficient to exclude a biliary cause.

• EUS
• Endoscopic ultrasound
• Idiopathic pancreatitis

• Choledocholithiasis
• Cholelithiasis
• Chronic pancreatitis
• Diagnosis
• Endoscopic ultrasonography
• Gallstones
• Idiopathic acute pancreatitis

Recurrent acute pancreatitis (RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. The initial evaluation fails to detect the cause of RAP in 10%-30% of patients, whose condition is classified as idiopathic RAP (IRAP). Idiopathic acute pancreatitis (IAP) is a diagnostic challenge for gastroenterologists. In view of associated morbidity and mortality, it is important to determine the aetiology of pancreatitis to provide early treatment and prevent recurrence. Endoscopic ultrasound (EUS) is an investigation of choice for imaging of pancreas and biliary tract. In view of high diagnostic accuracy and safety of EUS, a EUS based management strategy appears to be a reasonable approach for evaluation of patients with a single/recurrent idiopathic pancreatitis. The most common diagnoses by EUS in IAP is biliary tract disease. The present review aims to discuss the role of EUS in the clinical management and diagnosis of patients with IAP. It elaborates the diagnostic approach to IAP in relation to EUS and other different modalities. Controversial issues in IAP like when to perform EUS, whether to perform after first episode or recurrent episodes, comparison among different investigations and the latest evidence significance are detailed.

• Endoscopic ultrasound
• Pancreatitis
• ERCP
• MRCP
• USG
• CT
• Idiopathic recurrent pancreatitis
• Ascariasis
• Pancreatic cancer
• Biliary sludge
• Gallstones
• Microlithiasis
• Common bile duct stones

• Endosonography
• Humans
• Pancreatitis/diagnostic imaging

Magnetic resonance cholangiopancreatography (MRCP), MRCP after secretin stimulation (S-MRCP) and endoscopic ultrasonography (EUS) are all selected to diagnose pancreas divisum. However, the accuracies of three diagnosis remain unclear. The aim is to address the diagnostic accuracies of MRCP, S-MRCP and EUS on pancreas divisum. We searched PubMed, MEDLINE and EMBASE databases from inception to January, 2015. Of the 536 citations retrieved, 16 studies were included. For MRCP diagnosis on pancreas divisum, the area under the hierarchical summary receiver-operating characteristic (HSROC) curve was 0.90 (95% confidence interval [CI] 0.87 to 0.92), and for S-MRCP and EUS, 0.99 (95% CI 0.97 to 0.99) and 0.97 (95% CI 0.96 to 0.98). Sensitivity and specificity for MRCP were 0.59 (95% CI 0.45 to 0.71) and 0.99 (95% CI 0.96 to 1.00); for S-MRCP, 0.83 (95% CI 0.66 to 0.92) and 0.99 (95% CI 0.96 to 1.00); for EUS, 0.85 (95% CI 0.67 to 0.94) and 0.97 (95% CI 0.90 to 0.99). Comprehensive comparison of three diagnostic techniques to pancreas divisum, S-MRCP was more reliable than MRCP and EUS on the effect of the diagnostic test.

Acute recurrent pancreatitis (ARP) is defined as more than two attacks of acute pancreatitis with complete or almost complete resolution of symptoms and signs of pancreatitis between episodes. The initial evaluation fails to detect the cause of ARP in 10%–30% of patients, whose condition is classified as idiopathic ARP. Endoscopic ultrasound (EUS) has gained increasing attention as a useful imaging modality for the pancreas and the extrahepatic biliary tree. The close proximity of the pancreas to the digestive tract allows EUS to obtain detailed images of this organ. This review aims to record pancreaticobiliary endoscopic ultrasound (EUS) and other imaging modalities in the clinical management of patients with idiopathic ARP.

• endoscopic ultrasound
• idiopathic acute recurrent pancreatitis

• gastroenterology
• genetics
• inflammation
• molecular biology
• pediatrics

• Autoimmune pancreatitis
• Choledocholithiasis
• Endoscopic cystgastrostomy
• Fine-needle aspiration
• Pancreatitis
• Pediatric endoscopic ultrasound

• Child
• Digestive System Diseases/diagnostic imaging
• Endosonography/methods
• Humans
• Pediatrics/methods

AIM: To determine the impact of a clinical pathway (CP) on acute pancreatitis (AP) treatment outcome.

METHODS: A retrospective analysis of medical records was performed. We compared the results of AP treatment outcome over two time periods in our centre, before (2006-2007) and after (2010-2012) the implementation of a CP. The CP comprised the following indicators of quality: performance of all laboratory tests on admission (including lipids and carbohydrate deficient transferrin), determination of AP aetiology, abdomen ultrasound (US) within the first 24 h after admission, contrast-enhanced computed tomography of the abdomen in all cases of suspected pancreatic necrosis, appropriately selected and sufficiently used antibiotic therapy (if necessary), pain control, adequate hydration, control of haemodynamic parameters and transfer to the Intensive Care Unit (ICU) (if necessary), endoscopic retrograde cholangiopancreatography (ERCP) in biliary AP, surgical treatment (if necessary), and advice on outpatient follow-up after discharge. A comparison of the length of stay with that in other Slovenian hospitals was also performed.

RESULTS: There were 139 patients treated in the three-year period after the introduction of a CP, of which 81 (58.3%) were male and 58 (41.7%) female. The patients’ mean age was 59.6 ± 17.3 years. The most common aetiologies were alcoholism and gallstones (38.8% each), followed by unexplained (11.5%), drug-induced, hypertriglyceridemia, post ERCP (2.9% each) and tumours (2.2%). Antibiotic therapy was prescribed in 72 (51.8%) patients. Abdominal US was performed in all patients within the first 24 h after admission. Thirty-two (23.0%) patients were treated in the ICU. Four patients died (2.9%). In comparison to 2006-2007, we found an increased number of alcoholic and biliary AP and an associated decrease in the number of unexplained aetiology cases. The use of antibiotics also significantly decreased after the implementation of a CP (from 70.3% to 51.8%; P = 0.003). There was no statistically significant difference in mortality (1.8% vs 2.9%). The length of stay was significantly shorter when compared to the Slovenian average (P = 0.018).

CONCLUSION: The introduction of a CP has improved the treatment of patients with AP, as assessed by all of the observed parameters.

• Acute
• Pancreatitis
• Treatment
• Clinical pathway
• Indicator
• Quality

• Acute Disease
• Adult
• Aged
• Combined Modality Therapy
• Critical Pathways
• Female
• Humans
• Male
• Medical Records
• Middle Aged
• Pancreatitis/diagnosis
• Pancreatitis/mortality
• Pancreatitis/therapy
• Predictive Value of Tests
• Retrospective Studies
• Risk Factors
• Slovenia
• Time Factors
• Treatment Outcome

• benign
• diagnostic
• endoscopic ultrasonography
• pancreatic disease
• therapeutic

• Cholangiopancreatography
• Chronic/diagnosis/therapy
• Congenital abnormalities/epidemiology
• Endoscopic retrograde
• Pancreas/abnormalities
• Pancreatitis/complications

• Acute Disease
• Adolescent
• Adult
• Aged
• Child
• Endosonography/methods
• Gallstones/diagnostic imaging
• Humans
• Male
• Middle Aged
• Observational Studies as Topic
• Pancreatitis/diagnostic imaging
• Recurrence
• Young Adult

• ERCP/ES
• acute pancreatitis
• cholecystectomy
• recurrent pancreatitis
• unexplained etiology

Less than 67% of patients with intermediate risk for common bile duct (CBD) stones require therapeutic intervention. It is important to have an accurate, safe, and reliable method for the definitive diagnosis of CBD stones before initiating therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Few publications detail the diagnostic efficacy of linear echoendoscopy (EUS) for CBD stones.

30 patients with biliary colic, pancreatitis, unexplained derangement of liver function tests, and/or dilated CBD without an identifiable cause were enrolled in the study. When a CBD stone was disclosed by linear EUS, ERCP with stone extraction was performed. Patients who failed ERCP were referred for surgical intervention. If no stone was found by EUS, ERCP would not be performed and patients were followed-up for possible biliary symptoms for up to three months.

The major reason for enrollment was acute pancreatitis. The mean predicted risk for CBD stones was 47% (28–61). Of the 12 patients who were positive for CBD stones by EUS, nine had successful ERCP, one failed ERCP (later treated successfully by surgical intervention) and two were false-positive cases. No procedure-related adverse events were noted. For those 18 patients without evidence of CBD stones by EUS, no false-negative case was noted during the three-month follow-up period. Linear EUS had sensitivity, specificity, positive and negative predicted values for the detection of CBD stones of 1, 0.9, 0.8 and 1, respectively.

Linear EUS is safe and efficacious for the diagnosis of occult CBD stones in patients with intermediate risk for the disease.

AIM: To evaluate the diagnostic value of ERCP combined with detection of biliary microlithiasis for idiopathic acute pancreatitis (IAP).

METHODS: A total of 105 patients who were diagnosed with acute pancreatitis (AP) from January 2008 to January 2011 were included in this study. Forty-two patients with IAP, in whom no cause can be found after conventional imaging examinations, received diagnostic ERCP. For each patient, five milliliter of bile was collected and examined under a polarized light microscope immediately to detect biliary microlithiasis. Ninty AP patients were used as controls.

RESULTS: The diagnostic accuracy of conventional imaging examinations for the cause of AP was 55.5% (50/90), while that of ERCP combined with biliary microlithiasis examination was 87.5% (93/105), with a significant difference between the two groups (P < 0.05). ERCP combined with detection of biliary microlithiasis had a higher accuracy in the diagnosis of IAP.

CONCLUSION: ERCP combined with detection of biliary microlithiasis can improve the accuracy of diagnosis of IAP.

• Idiopathic pancreatitis
• Endoscopic retrograde cholangiopancreatography
• Biliary microlithiasis

Endoscopic ultrasound (EUS) is often used to detect the cause of acute pancreatitis (AP) after the acute attack has subsided. The limited data on its role during hospitalization for AP are reviewed here. The ability of EUS to visualize the pancreas and bile duct, the sonographic appearance of the pancreas, correlation of such appearance to clinical outcomes and the impact on AP management are analyzed from studies. The most important indication for EUS appears to be for detection of suspected common bile duct and/or gall bladder stones and microlithiasis. Such an approach might avoid diagnostic endoscopic retrograde cholangio-pancreatography with its known complications. The use of EUS during hospitalization for AP still appears to be infrequent but may become more frequent in future.

• Acute pancreatitis
• Endoscopic ultrasound
• Acute biliary pancreatitis
• Endoscopic retrograde cholangio-pancreatography
• Idiopathic pancreatitis

Idiopathic acute pancreatitis is a diagnostic challenge for gastroenterologists. The possibility of finding a cause for pancreatitis usually relies on how far the diagnostic study is taken. Endoscopic explorations such as endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography can help to determine the cause of pancreatitis. Furthermore, microscopic bile examination and magnetic resonance cholangiopancreatography can also be helpful in the work up of these patients. In this article an approximation to the diagnostic approach to patients with idiopathic acute pancreatitis is made, taking into account the reported evidence with which to choose between the different available explorations.

• Endosonography
• Cholangiopancreatography
• Endoscopic retrograde
• Cholangiopancreatography
• Magnetic resonance
• Microscopic bile examination
• Idiopathic pancreatitis
• Acute
• Diagnosis