Role of endoscopic ultrasonography in patients with first episode of idiopathic acute pancreatitis.
OBJECTIVE
Acute pancreatitis (AP) evades an etiological diagnosis in up to 10 % to 30 % of patients. This group, ie. idiopathic acute pancreatitis (IAP) is prone to a high recurrence (up to 70 %). Endoscopic ultrasound (EUS) is promising, but there is limited data on elucidating the cause of IAP, from India. This observational study was designed to study the role of EUS after the first episode of IAP.


METHODS
All patients diagnosed to have first episode of IAP were included in the study and taken up for EUS examination after 6 weeks. Patients with conditions known to predispose or precipitate AP, like alcohol binge, drugs, metabolic or autoimmune conditions, or even a positive family history, were excluded from the study.


RESULTS
A total of 51 patients were included. EUS positivity was found in 29 (56.9 %) patients. It included common bile duct (CBD) calculus in 5 (9.8 %), CBD sludge in 4 (7.8 %), gallbladder calculus in 2 (3.9 %), gallbladder sludge in 2 (3.9 %), and chronic pancreatitis (CP) in 16 (31.4 %) patients. Fourteen patients had a normal study and eight patients had indeterminate CP.


CONCLUSIONS
EUS is safe and has a reasonable diagnostic yield in patients with first episode of IAP. CP and biliary lithiasis are the most frequent positive findings on EUS. EUS should be included in the diagnostic protocol after the first episode of IAP, rather than waiting for recurrent episodes.
Department of Gastroenterology, Santobka Durlabhji Memorial Hospital, Near Rambagh Circle, Bhawani Singh Road, Bapu Nagar, Jaipur, 302 015, India, gutcare@hotmail.com.
Anurag
A
Govil
Mahendra Kumar
MK
Agrawal
Dinesh
D
Agrawal
Harsh
H
Udawat
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D019160:Endosonography / Q000379:methods*; D042882:Gallstones / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D010195:Pancreatitis / Q000000981:diagnostic imaging*; D012008:Recurrence; D055815:Young Adult