title: The role of intraductal US in the management of idiopathic recurrent pancreatitis without a definite cause on ERCP.
abstract: BACKGROUND
  The cause of pancreatitis is unknown in as many as 30% of cases of recurrent acute pancreatitis, even after ERCP.
  
  
  OBJECTIVE
  To investigate the role of intraductal US (IDUS) for managing idiopathic recurrent pancreatitis (IRP).
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Tertiary referral hospital.
  
  
  METHODS
  Thirty-one patients with suspicious IRP with negative findings on ERCP.
  
  
  METHODS
  IDUS during ERCP.
  
  
  METHODS
  IDUS findings showing any possible cause of pancreatitis.
  
  
  RESULTS
  IDUS revealed small bile duct stones (≤3 mm) in 5 patients (16.1%) and sludge in 3 patients (9.7%). The detection rate for a bile duct stone and sludge was significantly higher in patients with a dilated CBD than a nondilated CBD on ERCP (71.4 vs 12.5%; P < .05). Recurrent pancreatitis did not develop in 7 of 8 patients with biliary stones or sludge after an endoscopic sphincterotomy (EST). Two patients (6.5%) demonstrated a small polypoid lesion on the distal end of the pancreatic duct. One patient underwent surgery for intra-ampullary cancer, and another one underwent EST without another attack of pancreatitis. Three patients (9.7%) showed evidence of chronic pancreatitis with small pancreatic stones and/or calcifications on IDUS.
  
  
  CONCLUSIONS
  Small number of patients. IDUS results were not compared with those of conventional EUS. There was no reference standard for chronic pancreatitis as diagnosed by IDUS.
  
  
  CONCLUSIONS
  IDUS identified a possible cause of idiopathic recurrent pancreatitis in 42% of patients with negative findings on ERCP. The IDUS-guided approach combined with ERCP and EST may be useful for decreasing recurring attacks of pancreatitis.
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon and Seoul, Korea.
authors.forename: Hyun Su
authors.initials: HS
authors.lastname: Kim
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.forename: Jong Chan
authors.initials: JC
authors.lastname: Lee
authors.forename: Seung Hyo
authors.initials: SH
authors.lastname: Han
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Hong
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Young Koog
authors.initials: YK
authors.lastname: Cheon
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Moon Sung
authors.initials: MS
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D001646:Bile / Q000000981:diagnostic imaging; D002760:Cholangiopancreatography, Endoscopic Retrograde; D019160:Endosonography; D005260:Female; D042882:Gallstones / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000209:etiology*; D011127:Polyps / Q000150:complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012008:Recurrence