title: EUS finding of geographic hyperechoic area is an early predictor for severe acute pancreatitis.
abstract: OBJECTIVE
  Endoscopic ultrasonography (EUS) is an accurate imaging modality for delineating pancreatobiliary structures, however, its clinical application of acute pancreatitis (AP) is limited. Therefore, we sought to characterize the typical EUS features of AP and to determine whether early EUS findings may have prognostic significance.
  
  
  METHODS
  Between March 2008 and October 2010, 90 patients with AP and 90 patients without pancreatic disease who underwent EUS were enrolled. An EUS examination was performed within 48 h of admission in AP, and all EUS findings were retrospectively analyzed.
  
  
  RESULTS
  Among 90 patients, 27 (30%) were diagnosed with severe AP. Multivariate analysis revealed the presence of peripancreatic fluid (OR 13.9, 95%, CI: 1.6-123.6), heterogenous (OR 7.2, 95% CI: 1.7-30.4) and hypoechoic parenchymal echogenicity (OR 10.0, 95% CI: 3.9-25.8) were significant EUS features in AP, as compared to those in the control group. Comparison between mild and severe AP showed that geographic hyperechoic area (GHA) of pancreas was a predictive factor (OR 2.9, 95% CI: 1.1-8.2, p = 0.04) for the severe form, and that AP patients with GHA had significantly longer duration of fever, abdominal pain and hospital stay than those without GHA (5.5 vs. 1 day (s), p = 0.002; 4 vs. 3 days, p = 0.023; 11 vs. 8 days, p = 0.021, respectively).
  
  
  CONCLUSIONS
  Typical EUS features of AP are a heterogenous hypoechoic parenchymal changes with peripancreatic fluid collection. The novel EUS variable of GHA in the early phase of AP seems to have prognostic value and could be correlated with a worse clinical outcome.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kwandong University College of Medicine, Myongji Hospital, Goyang, Republic of Korea.
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cho
authors.forename: Tae Joo
authors.initials: TJ
authors.lastname: Jeon
authors.forename: Ja Sung
authors.initials: JS
authors.lastname: Choi
authors.forename: Hee Man
authors.initials: HM
authors.lastname: Kim
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Park
authors.forename: Yu Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Ki Jun
authors.initials: KJ
authors.lastname: Han
authors.forename: Hyeon Geun
authors.initials: HG
authors.lastname: Cho
authors.forename: Seungmin
authors.initials: S
authors.lastname: Bang
authors.forename: Si Young
authors.initials: SY
authors.lastname: Song
mesh_terms: D015746:Abdominal Pain; D000208:Acute Disease; D000328:Adult; D000368:Aged; D019160:Endosonography; D005260:Female; D005334:Fever; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D011379:Prognosis