title: Clinico-biochemical prediction of biliary cause of acute pancreatitis in the era of endoscopic ultrasonography.
abstract: BACKGROUND
  Occult biliary stones escape detection on conventional investigations, and clinico-biochemical systems proposed for predicting biliary pancreatitis has low predictive values.
  
  
  OBJECTIVE
  To evaluate the accuracy of clinico-biochemical parameters for prediction of biliary pancreatitis in patients undergoing endoscopic ultrasonography.
  
  
  METHODS
  Early endoscopic ultrasonography was performed on 139 patients presenting with acute pancreatitis within 24 h of admission. The aetiologies of all patients were determined after complete evaluations, and clinico-biochemical characteristics of patients with a biliary cause (biliary group) and non-biliary causes (non-biliary group) were compared.
  
  
  RESULTS
  Biliary pancreatitis was diagnosed in 107 patients and 32 patients had non-biliary causes. The biliary group belonged to a significantly older age group, had a female predominance, significantly more derangement of liver function and a higher incidence of severe attack of acute pancreatitis. On multivariate analysis, female sex, age >58 years and serum alanine aminotransferase >150 U/L were independent predictive factors for biliary cause of acute pancreatitis. Using these three factors for prediction of biliary cause, the sensitivity was 93% and overall accuracy was 85%.
  
  
  CONCLUSIONS
  Clinico-biochemical prediction for biliary cause of acute pancreatitis improves in the era of endoscopic ultrasonography with a higher sensitivity and overall accuracy. In centres where endoscopic ultrasonography is inaccessible or local expertise is unavailable, clinico-biochemical prediction of biliary cause of acute pancreatitis may provide a useful alternative in the initial management of this group of patients.
authors.affiliation: Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China. clliu@hkucc.hku.hk
authors.forename: C L
authors.initials: CL
authors.lastname: Liu
authors.forename: S T
authors.initials: ST
authors.lastname: Fan
authors.forename: C M
authors.initials: CM
authors.lastname: Lo
authors.forename: W K
authors.initials: WK
authors.lastname: Tso
authors.forename: Y
authors.initials: Y
authors.lastname: Wong
authors.forename: R T P
authors.initials: RT
authors.lastname: Poon
authors.forename: C M
authors.initials: CM
authors.lastname: Lam
authors.forename: B C
authors.initials: BC
authors.lastname: Wong
authors.forename: J
authors.initials: J
authors.lastname: Wong
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019160:Endosonography; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000209:etiology*; D011446:Prospective Studies