Endoscopic ultrasound diagnostic gain over computed tomography and magnetic resonance cholangiopancreatography in defining etiology of idiopathic acute pancreatitis

Table 1 Demographic and clinical features of the 64 patients analyzed

Parameter	n = 81	EUS diagnosis, n = 64	Missed EUS diagnosis, n = 17	P value
Male, n (%)	51 (63)	43 (67)	8 (46)	0.208
Age at enrollment, mean ± SD, yr	61 ± 18	62 ± 18	59 ± 16
Previous cholecystectomy, n (%)	19 (23)	18 (28)	0	0.028
Recurrent pancreatitis, n (%)	14 (17)	14 (22)	0	0.101
One episode, n (%)	7 (9)
≥ 2 episodes, n (%)	6 (7)
Amylase, median (range)	468 (107-4988)	465 (123-4988)	500 (107-4753)	0.861
Lipase, median (range)	777 (87-23840)	774 (87-23840)	780 (96-12800)	0.914
Gamma-glutamyl transpeptidase, median (range)	70 (9-1665)	70 (9-1665)	125 (11-640)	0.707
Alkaline phosphatase, median (range)	78 (32877)	78 (32-877)	90 (32-185)	0.707
Direct bilirubin, median (range)	0.7 (0.2-8.5)	0.4 (0.2-3)	0.7 (0.2-8.5)	0.933
Alanine aminotransferase, median (range)	34 (6-793)	34 (6-793)	33 (7-596)	0.488
Aspartate aminotransferase, median (range)	38 (11-704)	34 (11-704)	33 (15-301)	0.732
Abdominal US, n (%)	72 (89)	63 (98)	9 (54)	< 0.001
Abdominal CECT, n (%)	72 (89)	56 (88)	16 (94)	1.000
MRCP, n (%)	32 (39)	28 (44)	4 (24)	0.220
EUS findings, n (%)		NA	NA	NA
Normal (final IAP diagnosis)	17 (21)
Biliary	16 (20)
Microlithiasis / biliary sludge	9 (11)
Acute on chronic pancreatitis	25 (31)
Solid or cystic lesions	11 (14)
Pancreatic adenocarcinoma	4 (5)
Ampullary adenoma	2 (3)
BD-IPMN with high-risk stigmata or worrisome features	5 (6)
Pancreas divisum	4 (5)
Ductal anomaly	4 (5)
Autoimmune criteria	4 (5)

BD-IPMN: Branch-duct intraductal papillary mucinous neoplasms; CECT: Contrast enhanced computed tomography; IAP: Idiopathic acute pancreatitis; MRCP: Magnetic resonance cholangiopancreatography; SD: Standard deviation; US: Ultrasound; EUS: Endoscopic ultrasound; NA: Not available.

Table 2 Frequencies of acute pancreatitis etiologies at endoscopic ultrasound according to the type of previous negative exam/s

	Type of previous negative exam/s
Type of AP etiology at EUS	US	CECT	MRCP	US + CECT	US + MRCP	CECT + MRCP	US + CECT + MRCP
Biliary; microlithiasis/biliary sludge	20%; 10%	16%; 5%	17%; 17%	19%; 7%	18%; 18%	14%; 14%	16%; 16%
Acute on chronic	37%	29%	38%	32%	39%	33%	37%
Solid or cystic lesions	15%	14%	17%	15%	18%	19%	21%
Pancreas divisum	3%	6%	4%	5%	4%	5%	5%
Anomalous pancreaticobiliary junction	6%	6%	4%	7%	4%	5%	5%
Autoimmune criteria	6%	3%	4%	5%	4%	5%	5%
Idiopathic	13%	26%	16%	17%	3%	9%	11%

AP: Acute pancreatitis; CECT: Contrast enhanced computed tomography; EUS: Endoscopic Ultrasound; MRCP: Magnetic resonance cholangiopancreatography; US: Ultrasound.