Arianna Smith, DO, Srivats Madhavan, MD Medical College of Wisconsin, Milwaukee, WI
Introduction: Acute pancreatitis is an inflammatory disorder of the pancreas. In 10-30% of cases, etiology is considered idiopathic after initial testing. Interventions considered in evaluation of acute idiopathic pancreatitis (AIP) include endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP). Prior data suggest significant utility of EUS following negative MRCP. However, with improvements in MRI technology, the utility of invasive testing in AIP needs to be re-examined.
Methods: Single center, retrospective review was conducted on patients who underwent EUS for the diagnosis of pancreatitis between 2015 and 2019. Exclusion criteria included age < 18, EUS for reason other than pancreatitis, history of known pancreatic mass, and history of alcohol use ( >2 standard drinks/day men and >1/day women). Variables including number of prior episodes, family history, alcohol and tobacco use, LFTs, lipase, triglycerides, calcium, and imaging results were extracted via manual chart review. Comparisons between EUS findings and numeric variables were done with two-sample t-tests.
Results: 173 patients were included. A total of 61 patients (34%) had findings on EUS that differed from findings on MRCP, and 23 patients (13%) had a new finding on EUS that contributed to the final diagnosis of pancreatitis etiology (Table 1). Significant P-values for above-mentioned variables collected, include peak alkaline phosphatase elevated >2x upper limit normal (ULN), p=0.001. No other variables correlated with significant difference in EUS yield.
Discussion: Our data suggest new findings on EUS compared to MRCP in only 34% of patients, and interestingly, only contributed to final pancreatitis etiology in 13% of patients. This differs from current meta-analysis data that suggests EUS yields diagnosis in 64% of patients1. Our data suggests that when etiology remains idiopathic following negative RUQ US and MRCP, diagnostic yield of EUS is significantly lower than current literature suggests except in patients with any past elevation of alkaline phosphatase >2x ULN, who may benefit from EUS. Advances in MRI technology in the last 15-20 years may result in increased detection without need for EUS, explaining differences seen in data from this study. Wan J, Ouyang Y, Yu C, Yang X, Xia L, and Lu N. Comparison of EUS with MRCP in idiopathic acute pancreatitis: a systematic review and meta-analysis. Gastrointest Endosc 2018;87(5):1180-1188.
Disclosures:
Arianna Smith indicated no relevant financial relationships.
Srivats Madhavan indicated no relevant financial relationships.
Arianna Smith, DO, Srivats Madhavan, MD. P2284 - Endoscopic Ultrasound in Acute Idiopathic Pancreatitis: Has Its Diagnostic Yield Changed?, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
