scholarly journals Utility of endoscopic ultrasound in idiopathic acute recurrent pancreatitis

2021 ◽  
Vol 8 (1) ◽  
pp. e000538
Author(s):  
Alejandra Tepox-Padrón ◽  
Rafael Ambrosio Bernal-Mendez ◽  
Gilberto Duarte-Medrano ◽  
Adriana Fabiola Romano-Munive ◽  
Milton Mairena-Valle ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Endoscopic Ultrasound ◽  
Complete Resolution ◽  
Diagnostic Yield ◽  
Recurrent Pancreatitis ◽  
Mucinous Neoplasm ◽  
Possible Cause ◽  
Symptoms And Signs

Idiopathic acute recurrent pancreatitis (IARP) is defined as at least two episodes of acute pancreatitis with the complete or near-complete resolution of symptoms and signs of pancreatitis between episodes, without an identified cause. There is a paucity of information about the usefulness of endoscopic ultrasound (EUS) in IARP.ObjectivesTo determine the diagnostic yield of EUS in IARP.DesignA retrospective study was performed in patients with IARP evaluated by EUS between January 2009 and December 2016. Follow-up assessments of acute pancreatitis recurrence were carried out.ResultsSeventy-three patients with 102 EUS procedures were included. EUS was able to identify the cause of IARP in 55 patients (75.3%). The most common findings were chronic pancreatitis in 27 patients (49.1%), followed by lithiasic pathology in 24 patients (43.6%), and intraductal papillary mucinous neoplasm in four patients (7.3%). A directed treatment against EUS findings had a protective tendency associated with the final resolution of recurrence. There were no complications reported.ConclusionEUS performed in patients with IARP helped to identify a possible cause in 2/3 of the cases. The majority of patients have a treatable disease.

scholarly journals Comparing the Roles of EUS, ERCP and MRCP in Idiopathic Acute Recurrent Pancreatitis

2016 ◽  
Vol 9 ◽  
pp. CGast.S37927 ◽  
Author(s):  
Mohammad Taghi Safari ◽  
Mohammad Bager Miri ◽  
Shahram Ebadi ◽  
Shabnam Shahrokh ◽  
Amir Houshang Mohammad Alizadeh
Keyword(s):  
Acute Pancreatitis ◽  
Endoscopic Ultrasound ◽  
Clinical Management ◽  
Complete Resolution ◽  
Imaging Modality ◽  
Biliary Tree ◽  
Recurrent Pancreatitis ◽  
Close Proximity ◽  
Extrahepatic Biliary Tree ◽  
Symptoms And Signs

Acute recurrent pancreatitis (ARP) is defined as more than two attacks of acute pancreatitis with complete or almost complete resolution of symptoms and signs of pancreatitis between episodes. The initial evaluation fails to detect the cause of ARP in 10%-30% of patients, whose condition is classified as idiopathic ARP. Endoscopic ultrasound (EUS) has gained increasing attention as a useful imaging modality for the pancreas and the extrahepatic biliary tree. The close proximity of the pancreas to the digestive tract allows EUS to obtain detailed images of this organ. This review aims to record pancreaticobiliary endoscopic ultrasound (EUS) and other imaging modalities in the clinical management of patients with idiopathic ARP.

scholarly journals Bilobular pancreas: another variant of the divided pancreas?

2006 ◽  
Vol 63 (10) ◽  
pp. 902-904 ◽  
Author(s):  
Dragana Zivanovic ◽  
Vojislav Perisic
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Disease ◽  
Recurrent Pancreatitis ◽  
Adequate Diet ◽  
Dorsal Pancreas ◽  
Full Control ◽  
Endoscopic Cholangiopancreatography ◽  
Key Factor ◽  
Ventral And Dorsal Pancreas ◽  
Possible Cause

Background. Pancreas divisum is the most common anomaly of the pancreas. This anomaly has been known as a possible cause of recurrent pancreatitis. Case report. We performed computerized tomography (CT) of the abdomen in 5 children in whom a divided pancreas was confirmed using endoscopic cholangiopancreatography. In a girl, who had three episodes of severe acute pancreatitis, a CT examination confirmed a completely divided embryonal dorsal and ventral primordium. We named this variant of the divided pancreas the "bilobular pancreas". Contrary to the remaining 4 children in whom the control of the number and severity of attacks, as well as the control of pancreatic pain were achieved by pharmacotherapeutics and an adequate diet, in the reported patient sphincteroplasty of the papilla duodeni minor resulted in a full control of the disease. Conclusion. The paper discussed the possibility that the variant of the divided pancreas, with anatomically completely separated ventral and dorsal pancreas and their ductal systems, is the key factor that determines the severity of pancreatic disease and an indication for sphincteroplasty of the papilla duodeni minor as the major therapeutic method.

scholarly journals Endoscopic Ultrasound-Guided Drainage without Fluoroscopic Guidance for Extraluminal Complicated Cysts

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Hyeong Seok Nam ◽  
Hyung Wook Kim ◽  
Dae Hwan Kang ◽  
Cheol Woong Choi ◽  
Su Bum Park ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Complete Resolution ◽  
Symptomatic Improvement ◽  
Lesion Size ◽  
Endoscopic Drainage ◽  
Fluoroscopic Guidance ◽  
The Mean ◽  
Fluid Collections ◽  
Mean Time

Background. Endoscopic ultrasound- (EUS-) guided drainage is generally performed under fluoroscopic guidance. However, improvements in endoscopic and EUS techniques and experience have led to questions regarding the usefulness of fluoroscopy. This study aimed to retrospectively evaluate the safety and efficacy of EUS-guided drainage of extraluminal complicated cysts without fluoroscopic guidance.Methods. Patients who had undergone nonfluoroscopic EUS-guided drainage of extraluminal complicated cysts were enrolled. Drainage was performed via a transgastric, transduodenal, or transrectal approach. Single or double 7 Fr double pigtail stents were inserted.Results. Seventeen procedures were performed in 15 patients in peripancreatic fluid collections (n=13) and pelvic abscesses (n=4). The median lesion size was 7.1 cm (range: 2.8–13.0 cm), and the mean time spent per procedure was26.2±9.8minutes (range: 16–50 minutes). Endoscopic drainage was successful in 16 of 17 (94.1%) procedures. There were no complications. All patients experienced symptomatic improvement and revealed partial to complete resolution according to follow-up computed tomography findings. Two patients developed recurrent cysts that were drained during repeat procedures, with eventual complete resolution.Conclusion. EUS-guided drainage without fluoroscopic guidance is a technically feasible, safe, and effective procedure for the treatment of extraluminal complicated cysts.

scholarly journals Acute Pancreatitis and Acute Recurrent Pancreatitis: Investigation of Clinical and Etiological Factors

2021 ◽  
Author(s):  
Ferda Özbay Hoşnut ◽  
Gülseren Şahin ◽  
Ayla Akça Çağlar ◽  
Naz Güleray ◽  
Derya Erdoğan
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Congenital Anomalies ◽  
Clinical Laboratory ◽  
Common Factor ◽  
Hereditary Pancreatitis ◽  
Recurrent Pancreatitis ◽  
Common Causes ◽  
Idiopathic Acute Pancreatitis ◽  
Day By Day

INTRODUCTION: It was aimed to evaluate the etiology, clinical, laboratory and imaging findings and treatment methods of patients who have admitted with acute pancreatitis (AP) and progressed to chronic pancreatitis (CP) with ARP (acute recurrent pancreatitis). METHODS: The data of children under the age of 18 years who were admitted to our hospital between January 2013-July 2020 and were diagnosed with acute, acute recurrent or chronic pancreatitis according to INSPPIRE diagnostic criteria were evaluated retrospectively. RESULTS: There were 77 patients who were followed-up with the diagnosis of acute pancreatitis. Pancreatitis attack did not recur in 53/77 patients and no underlying cause was found in 35.84% (19/53) of the patients. The most common factor in those whose cause could be determined was gallstones (15.1%) (8/53). The pancreatitis attack recurred in 24 (31%) of the patients. Congenital anomalies (9/24) and hereditary pancreatitis (5/24) were the most common causes of pancreatitis in these patients and these factors were a risk factor for the recurrence of pancreatitis attack. There was no difference between the groups in terms of complications (p=0.423); however, chronicity was more common in the group with ARP (p=0.003). DISCUSSION AND CONCLUSION: Beside the pancreatitis is a rare disease in childhood, with the increase of awareness and increased accessibility to diagnostic imaging methods, more and more pancreatitis is diagnosed day by day. Idiopathic acute pancreatitis cases still constitute the largest group. If other causes are excluded in these cases, it is important to investigate congenital anomalies, genetic and metabolic etiologies

scholarly journals Follow-up of patients with pseudotumoral chronic pancreatitis: outcome and surveillance

2018 ◽  
Vol 40 (2) ◽  
pp. 29-35
Author(s):  
F. I. Téllez-Âvila ◽  
Â. Villalobos-Garita ◽  
M. Giovannini ◽  
C. Chan ◽  
J. Hernandez-Calleros ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Chronic Pancreatitis ◽  
Pancreatic Adenocarcinoma ◽  
Endoscopic Ultrasound ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Surveillance Interval ◽  
Mass Lesions ◽  
Space Occupying Lesion

Aim: to follow up patients with pseudotumoral chronic pancreatitis (PCP) to assess their outcome and identify an optimal surveillance interval. Methods: data obtained prospectively were analyzed in a retrospective manner. Patients with clinical evidence of chronic pancreatitis (abdominal pain in the epigastrium, steatorrhea, and diabetes mellitus), endoscopic ultrasound (EUS) criteria > 4, and EUS-fine needle aspiration (FNA) were included. A pseudotumor was defined as a non-neoplastic space-occupying lesion, a cause of chronic pancreatitis that may mimic changes typical of pancreatic cancer on CT or endoscopic ultrasound but without histological evidence. A real tumor was defined as a neoplastic space-occupying lesion because of pancreatic cancer confirmed by histology. Results: thirty-five patients with chronic pancreatitis were included, 26 (74.2%) of whom were men. Nine (25.7%) patients were diagnosed with PCP and two (2/35; 5.7%) patients with PCP were diagnosed with pancreatic cancer on follow-up. The time between the diagnosis of PCP and pancreatic adenocarcinoma was 35 and 30 days in the two patients. Definitive diagnosis of pancreatic adenocarcinoma was made by surgery. In the remaining six patients with PCP, the median of follow-up was 11 months (range 1–22 months) and they showed no evidence of malignancy on surveillance. In the follow-up of patients without PCP but with chronic pancreatitis, none were diagnosed with pancreatic cancer. According to our data, older patients with chronic pancreatitis are at risk of PCP. Conclusion: according to characteristics of patient, detection of PCP should lead a surveillance program for pancreatic cancer with EUS-FNA in < 1 month or directly to surgical resection. Core tip: actually, there are no clear recommendations for follow-up of patients with chronic pancreatitis and solid pancreatic mass lesions. We followed-up patients with chronic pancreatitis and solid pancreatic mass lesions and we assessed the final outcome and identified an optimal surveillance interval. We found that almost one-third of patients with chronic pancreatitis had PCP, and 22.2% had unresectable pancreatic adenocarcinoma less than 2 mo after the initial diagnosis. Endoscopic ultrasound fine needle aspiration can miss malignancy in nearly 25% of patients with PCP.

scholarly journals Pancreatic Tuberculosis or Autoimmune Pancreatitis

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Ayesha Salahuddin ◽  
Muhammad Wasif Saif
Keyword(s):  
Chronic Pancreatitis ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Autoimmune Pancreatitis ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Immunoglobulin G4 ◽  
Fine Needle ◽  
Pancreatic Tuberculosis

Introduction. Isolated pancreatic and peripancreatic tuberculosis is a challenging diagnosis due to its rarity and variable presentation. Pancreatic tuberculosis can mimic pancreatic carcinoma. Similarly, autoimmune pancreatitis can appear as a focal lesion resembling pancreatic malignancy. Endoscopic ultrasound-guided fine needle aspiration provides an effective tool for differentiating between benign and malignant pancreatic lesions. The immune processes involved in immunoglobulin G4 related systemic diseases and tuberculosis appear to have some similarities.Case Report. We report a case of a 59-year-old Southeast Asian male who presented with fever, weight loss, and obstructive jaundice. CT scan revealed pancreatic mass and enlarged peripancreatic lymph nodes. Endoscopic ultrasound-guided fine needle aspiration confirmed the presence ofmycobacterium tuberculosis. Patient also had high immunoglobulin G4 levels suggestive of autoimmune pancreatitis. He was started on antituberculosis medications and steroids. Clinically, he responded to treatment. Follow-up imaging showed findings suggestive of chronic pancreatitis.Discussion. Pancreatic tuberculosis and autoimmune pancreatitis can mimic pancreatic malignancy. Accurate diagnosis is imperative as unnecessary surgical intervention can be avoided. Endoscopic ultrasound-guided fine needle aspiration seems to be the diagnostic test of choice for pancreatic masses. Long-term follow-up is warranted in cases of chronic pancreatitis.

scholarly journals A Suspected Case Of Endoscopic Ultrasound Induced Pancreatitis, Without Fine Needle Aspirate

2016 ◽  
Vol 10 (4) ◽  
Author(s):  
Michael John Abunassar BSc, BA, MD ◽  
Loree Boyle, BN, MD, FRCPC ◽  
Avijit Chaterjee, MSc, MDCM. FRCPC
Keyword(s):  
Acute Pancreatitis ◽  
Endoscopic Ultrasound ◽  
Pancreatic Cyst ◽  
Epigastric Pain ◽  
Stable Condition ◽  
Suspected Case ◽  
Fine Needle Aspirate ◽  
Recurrent Pancreatitis ◽  
Fine Needle ◽  
History Of

A 78-year-old male developed nausea and epigastric pain 8 hours following an endoscopic ultrasound (EUS) procedure. The patient had a history of recurrent pancreatitis, and underwent the EUS procedure with the aim of aspirating a pancreatic cyst. The cyst had regressed in size, in keeping with a pseuodocyst, and was not biopsied. The patient tolerated the procedure well with no immediate complications, and was discharged home in stable condition. Eight hours later, the patient developed acute pancreatitis.

scholarly journals Endoscopic ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts

2008 ◽  
Vol 45 (1) ◽  
pp. 17-21 ◽  
Author(s):  
César Vivian Lopes ◽  
Christian Pesenti ◽  
Erwan Bories ◽  
Fabrice Caillol ◽  
Marc Giovannini
Keyword(s):  
Acute Pancreatitis ◽  
Endoscopic Ultrasound ◽  
Pancreatic Pseudocysts ◽  
Ultrasound Guided ◽  
Traditional Treatment ◽  
Plastic Stent ◽  
Secondary Infections ◽  
Fluoroscopic Control ◽  
Transmural Drainage

BACKGROUND: Surgery is the traditional treatment for symptomatic pancreatic pseudocysts, but the morbidity is still too high. Minimally invasive endoscopic approaches have been encouraged. AIMS: To evaluate the efficacy of endoscopic ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts. METHODS: From January, 2003 to August, 2006, 31 consecutive symptomatic patients submitted to 37 procedures at the same endoscopic unit were retrospectively analysed. Chronic and acute pancreatitis were found in, respectively, 17 (54.8%) and 10 (32.3%) cases. Bulging was present in 14 (37.8%) cases. Cystogastrostomy or cystoduodenostomy were created with an interventional linear echoendoscope under endosonographic and fluoroscopic control. By protocol, only a single plastic stent, without nasocystic drain, was used. Straight or double pigtail stents were used in, respectively, 22 (59.5%) and 15 (40.5%) procedures. RESULTS: Endoscopic ultrasound-guided transmural drainage was successful in 29 (93.5%) patients. Two cases needed surgery, both due to procedure-related complications. There was no mortality related to the procedure. Twenty-four patients were followed-up longer than 4 weeks. During a mean follow-up of 12.6 months, there were six (25%) symptomatic recurrences due to stent clogging or migration, with two secondary infections. Median time for developing complications and recurrence of the collections was 3 weeks. These cases were successfully managed with new stents. Complications were more frequent in patients treated with straight stents and in those with a recent episode of acute pancreatitis. CONCLUSIONS: Endoscopic transmural drainage provides an effective approach to the management of pancreatic pseudocysts.

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