EUS in Exploring the Etiology of Mild Acute Biliary Pancreatitis With a Negative Finding of Biliary Origin by Conventional Radiological Methods

Xianbao Zhan; Xiaorong Guo; Yan Chen; Yuanhang Dong; Qihong Yu; Kaixuan Wang; Zhaoshen Li

Disclosures

J Gastroenterol Hepatol. 2011;26(10):1500-1503. 

In This Article

Results

A total of 223 patients with mild ABP underwent both US and CT examinations. Of these patients, extra MRCP was performed in 106 cases, because no certain biliary etiology was found or an equivocal positive biliary disorder was detected after US and CT. There were 37 patients with negative results following the above-mentioned conventional methods, and EUS was conducted in 33 of them (13 male and 20 female patients, 46.5 ± 20.7 years of age. Twenty-nine of these patients suffered from their first attack of biliary pancreatitis, while another four cases presented with 2–3 recurrent attacks). The details of each method are described in Table 1. All of the patients tolerated the procedures well without any complications.

In the 33 patients with unknown biliary etiologies after US, CT, and MRCP examinations, EUS identified abnormalities associated with mild acute pancreatitis in 14 cases (42.4%), biliary stones with sizes varying from 2.2 mm to 5.2 mm in 11 cases (5 cases with gall stones, 4 with CBD stones, and 2 with both), biliary sludge in two cases (as confirmed by subsequent ERCP), and ampullary adenocarcinoma with a size of 6 mm × 5 mm in one case (as confirmed by subsequent ERCP-guided brush sampling and cytological examinations).

In the total study population, gallstones are suspected to be the most likely cause of mild ABP, being observed in 138 cases (61.9%) with common bile duct stones alone and primary choledocholithiasis as the indications for ERCP; 36 cases (26.1%) presented either gallstones alone or both gallstones and CBD stones. In addition, there were 59 cases (26.5%) with sludge in the CBD or gallbladder. Additionally, other biliary pathologies were identified, such as ampullary adenocarcinoma in one case, biliary ascariasis in one case, and duodenal papillitis in two cases.

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