Imaging tests for accurate diagnosis of acute biliary pancreatitis (original) (raw)
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Acute biliary pancreatitis: detection of common bile duct stones with endoscopic ultrasound
European Journal of Gastroenterology & Hepatology, 2008
Objectives To determine prospectively the sensitivity and specificity of endoscopic ultrasound (EUS) for detecting common bile duct stones (CBS) in patients with acute biliary pancreatitis in whom transabdominal ultrasound was negative for CBS. Methods In 38 consecutive patients with acute biliary pancreatitis who were negative for CBS by transabdominal ultrasound, EUS was performed before endoscopic retrograde cholangiopancreatography (ERCP). The endoscopist performing ERCP was blind to the results of EUS. The primary goal of EUS and ERCP was to confirm or exclude CBS. The reference standard for CBS was endoscopic extraction of bile duct stones after endoscopic sphincterotomy. When both procedures, EUS and ERCP excluded CBS, it was assumed that there were no CBS and endoscopic sphincterotomy was not performed. The results EUS and ERCP were compared with the McNemar test. Results Twenty-five of the 38 patients (66%) had CBS. EUS and ERCP were false negative in one patient each, EUS was false positive in two patients and ERCP in one patient. The sensitivity of both EUS and ERCP was 96%. The specificity of EUS and ERCP was 85 and 92%, respectively. The difference between EUS and ERCP was not significant (P = 0.9). Conclusion EUS proved to be as sensitive as ERCP for detection of CBS in patients with acute biliary pancreatitis. Therefore, EUS could be used as the first-line procedure in patients with acute biliary pancreatitis when therapeutic ERCP is not needed. By this approach a substantial number of unnecessary diagnostic ERCP procedures could be avoided.
Alimentary Pharmacology and Therapeutics, 2005
Background: Occult biliary stones escape detection on conventional investigations, and clinico-biochemical systems proposed for predicting biliary pancreatitis has low predictive values. Aim: 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%. Conclusion: 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.
Prospective assessment of the utility of EUS in the evaluation of gallstone pancreatitis
Gastrointestinal Endoscopy, 1999
Gallstones are responsible for about half of the cases of acute pancreatitis in Europe and North America. 1-3 Although the exact mechanism of biliary pancreatitis is not understood, gallstone migration into the common bile duct is presumed to initiate pancreatitis. 2,4-6 Hypothesizing that the severity of acute biliary pancreatitis may be somehow related to the persistent presence of gallstones in the common bile duct, studies have focused on evaluating the benefits of early endoscopic extraction of these stones. The first published randomized trial of urgent ERCP from England demonstrated that endoscopic sphincterotomy with stone extraction performed within 72 hours of admission decreased morbidity and shortened hospital stay in the subgroup of patients predicted to have severe pancreatitis. 7 Subsequently, another randomized trial from Hong Kong that included patients with pancreatitis from causes other than gallstones demonstrated that emergent ERCP (with endoscopic sphincterotomy when bile duct stones were identified) performed within 24 hours decreased the rate of biliary sepsis in all patients with pancreatitis. 8 However, a more recent randomized multicenter investigation Background: The ability to identify common bile duct stones by noninvasive means in patients with acute biliary pancreatitis is limited. The aim of this study was to prospectively evaluate the ability of endosonography (EUS) to identify cholelithiasis and choledocholithiasis and predict disease severity in patients with nonalcoholic pancreatitis.
Objectives. Causes may be found in most cases of acute pancreatitis, however no etiology is found by clinical, biological and imaging investigations in 30% of these cases. Our objective was to evaluate results from endoscopic ultrasonography (EUS) for diagnosis of gallbladder microlithiasis in patients with unexplained (idiopathic) acute pancreatitis. MethOds. Thirty-six consecutive non-alcoholic patients with diagnoses of acute pancreatitis were studied over a five-year period. None of them showed signs of gallstones on transabdominal ultrasound or tomography. We performed EUS within one week of diagnosing acute pancreatitis. Diagnosis of gallbladder microlithiasis on EUS was based upon findings of hyperechoic signals of 0.5-3.0 mm, with or without acoustic shadowing. All patients (36 cases) underwent cholecystectomy, in accordance with indication from the attending physician or based upon EUS diagnosis. Results. Twenty-seven patients (75%) had microlithiasis confirmed by histology and nine did not (25%). EUS findings were positive in twenty-five. Two patients had acute cholecystitis diagnosed at EUS that was confirmed by surgical and histological findings. In two patients, EUS showed cholesterolosis and pathological analysis disclosed stones not detected by EUS. EUS diagnosed microlithiasis in four cases not confirmed by surgical treatment. In our study, sensitivity, specificity and positive and negative predictive values to identify gallbladder microlithiasis (with 95% confidence interval) were respectively. Overall EUS accuracy was 83.2%. cOnclusiOns. EUS is a very reliable procedure to diagnose gallbladder microlithiasis and should be used for the management of patients with unexplained acute pancreatitis. This procedure should be part of advanced endoscopic evaluation.
Endoscopy, 2011
Since its introduction in early 1990s, endoscopic ultrasound (EUS) has become integral to the diagnosis and staging of various luminal, extraluminal gastrointestinal (GI) and certain non-GI lesions. There is no data on EUS experience in Bangladesh. The aim of this paper is to evaluate the initial recent experience and clinical impact of EUS. All EUS procedures data were recorded prospectively from July 2013 to December 2014. These included patients' demographics, referral details, provisional diagnosis, management plan before and after EUS & indications of procedures. EUS-FNA data recorded included details regarding site, number of passes and histological diagnosis. Two hundred & four EUS procedures were carried out over one and half years. Male female ratio was 1.4:1, mean age was 46.4±20 years. Of these procedures 148 (72.5%) were referrals from physicians and 56 (27.5%) were from surgeons. Most common indications were pancreatobiliary pathologies, esophageal & gastric pathologies. Pancreatobiliary lesions (n=165, 80.9%) included patients with (A) Benign pathologies: Microliths in Gall baldder (n=6), Gall stones (n=12), Biliary ascarrisis (n=22), Choledocholithiasis (n=42), Acute Pancreatitis (n=9), Chronic Pancreatitis (n=15), Pancreatic pseudocysts(n=4) (B) Malignant Pathologies : GB Carcinoma(n=4), Cholangiocarcinoma (n=29), Capancreas (n=9), Periampullary carcinoma (n=12).Esophageal lesion was 9.3% (n = 19) of total procedures. Forty seven percent (n=9) of EUS procedures on esophagus were for staging of esophageal malignancy, 10. 5% (n=2) for restaging or recurrence after chemoradiation and 21% (n=4) for submucosal lesions. Fifteen EUS procedures were carried out for gastric lesions, 07 were for staging of gastric carcinoma, 04 were for assessment of submucosal lesions (e.g. GIST, lipoma or external compression), 02 for assessment of polyps and 02 for gastric ulcers.In clinical impact & outcome study, changes in diagnosis, management, avoidance of investigations and usefulness of EUS were evaluated. Diagnosis was changed in 34.4% (64/186) & management was changed in 45%(92/204). Additional investigation was avoided in 57.8% (118/204). This is the first report of Bangladesh experience of EUS to date. EUS is safe, accurate, cost effective & very useful tool for diagnosis and management of G.I. disorders.
Role of Ultrasonography in Diagnosis of Biliary Tract Diseases: A Single Centre Experience
SSR Institute of International Journal of Life Sciences, 2024
Background: The development of new diagnostic imaging techniques has not eliminated the challenge of diagnosing right upper quadrant pain in some patients. This challenge persists for both clinicians and radiologists. To study the role of ultrasonography in diagnosing biliary tract diseases. Methods: This study included patients suspected of having biliary tract diseases who were admitted to the surgical wards of Shri Jagannath Medical College and Hospital, Puri, between August 2021 and July 2023. Results: Among the 104 patients in this study, 36 (34.6%) were diagnosed with acute cholecystitis through surgery and pathological examination. Ultrasonography identified acute cholecystitis in 44 patients. Of these, there were 34 true-positive diagnoses, 10 false-positive diagnoses (8 interpreted as chronic cholecystitis and 2 others), and 2 false-negative diagnoses. Maximal focal tenderness was located over the gallbladder fossa in 34 of the 36 patients with surgically and pathologically confirmed acute cholecystitis. Conclusion: Due to its advantages of being inexpensive, non-invasive, and time-saving (particularly for critically ill patients), along with its high sensitivity, specificity, and accuracy, ultrasound has become the primary modality for investigating and managing biliary tract diseases.
Acute biliary pancreatitis: when should the endoscopist intervene?
Gastroenterology, 2003
A 63-year-old woman is admitted to the hospital with acute pancreatitis of presumed biliary origin. Laboratory results include white blood cell count (WBC) 18,500; hemoglobin 13.0; platelets 191,000; alanine aminotransferase (ALT) 330; aspartate aminotransferase (AST) 260; alkaline phosphatase 250; bilirubin 1.4; glucose 225; blood urea nitrogen (BUN) 47; creatinine 1.4; and prothrombin time 12 seconds. Ultrasound shows gallstones in the gallbladder; the common bile duct is 5 mm without stones identified.
Role Ultrasonography Diagnosis Biliary Tract Diseases
Background: The development of new diagnostic imaging techniques has not eliminated the challenge of diagnosing right upper quadrant pain in some patients. This challenge persists for both clinicians and radiologists. To study the role of ultrasonography in diagnosing biliary tract diseases. Methods: This study included patients suspected of having biliary tract diseases who were admitted to the surgical wards of Shri Jagannath Medical College and Hospital, Puri, between August 2021 and July 2023. Results: Among the 104 patients in this study, 36 (34.6%) were diagnosed with acute cholecystitis through surgery and pathological examination. Ultrasonography identified acute cholecystitis in 44 patients. Of these, there were 34 true-positive diagnoses, 10 false-positive diagnoses (8 interpreted as chronic cholecystitis and 2 others), and 2 false-negative diagnoses. Maximal focal tenderness was located over the gallbladder fossa in 34 of the 36 patients with surgically and pathologically confirmed acute cholecystitis. Conclusion: Due to its advantages of being inexpensive, non-invasive, and time-saving (particularly for critically ill patients), along with its high sensitivity, specificity, and accuracy, ultrasound has become the primary modality for investigating and managing biliary tract diseases.